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Cho HJ, Park SC, Lee JM, Jung NY, Park JB. Pediatric Eosinophilic Granuloma Associated With Delayed Epidural Hematoma Following on Seizure: A Case Report. Brain Tumor Res Treat 2024; 12:148-151. [PMID: 38742265 PMCID: PMC11096632 DOI: 10.14791/btrt.2024.0018] [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: 04/08/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
Eosinophilic granuloma (EG), a subtype of Langerhans cell histiocytosis (LCH), the monostotic form, is a rare condition characterized by a solitary bone lesion. It is even more unusual for this condition to be accompanied by an epidural hematoma (EDH). This case is unique in that it is the first to involve delayed EDH following a seizure. We describe a remarkable example of EG accompanied by an EDH and consider the rarity of this comorbidity. A 32-month-old boy developed a rapidly growing skull mass following a minor head injury. During surgical preparation for a biopsy, the patient experienced a single convulsion. Imaging following the seizure revealed an EDH in the vicinity of the mass. The mass was excised and confirmed to be an EG, but with positive margins. The patient underwent chemotherapy after systemic skeletal evaluation, in accordance with the LCH III protocol established by the Histiocytosis Society. EG is a rare neoplasm that typically presents as a painless growth on the skull that gradually enlarges over time. The correlation between EG and EDH is exceedingly uncommon, with only a few documented cases. This case study underscores the significance of considering EG in the differential diagnosis of an expanding cranium mass, even when associated with EDH. Prompt diagnosis and treatment can prevent serious complications and improve patient outcomes.
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Affiliation(s)
- Hyun Jeong Cho
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Chan Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Min Lee
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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2
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Benato A, Riva G, Raneri F. Eosinophilic granuloma of the calvarium: is conservative management a valid option? Illustrative case and systematic review of the literature. Childs Nerv Syst 2023; 39:2221-2227. [PMID: 36939904 PMCID: PMC10025804 DOI: 10.1007/s00381-023-05926-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Eosinophilic granuloma (EG) is the most common form of Langerhans cell histiocytosis, presenting as a single osteolytic lesion of the calvarium. Its diagnosis is based on typical clinical and radiological features. While surgical resection has been the standard treatment for EG, growing evidence favors watchful waiting, as unifocal calvarial lesions appear to frequently undergo spontaneous remission. However, histopathological confirmations of this hypothesis are still very limited. METHODS Methods. Here, we report a case of EG with typical clinical and radiological features which, due to intervening circumstances, was resected in a delayed fashion. Moreover, we perform a systematic review of the literature on conservative management of EG. RESULTS In our case, histological examination showed ongoing bone regeneration with no traces of the disease. Through our literature review, we found 47 cases of calvarial EG managed with watchful waiting. No active intervention was required in 43 cases (91%). Four patients (9%) received surgery or chemotherapy due to the persistence/progression of symptoms or family request. Three reports other than ours documented spontaneous disease remission in surgically resected EG upon histopathological examination. CONCLUSION Our report provides further evidence that watchful waiting can be a reasonable option in the management of single calvarial EG.
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Affiliation(s)
- Alberto Benato
- Department of Neurosurgery, ULSS8 Berica, Vicenza, Italy.
| | - Giulio Riva
- Department of Pathology, ULSS8 Berica, Vicenza, Italy
| | - Fabio Raneri
- Department of Neurosurgery, ULSS8 Berica, Vicenza, Italy
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3
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Tu CQ, Chen ZD, Yao XT, Jiang YJ, Zhang BF, Lin B. Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation: A case report. World J Clin Cases 2023; 11:4944-4955. [PMID: 37583995 PMCID: PMC10424031 DOI: 10.12998/wjcc.v11.i20.4944] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Eosinophilic granuloma (EG) is a proliferative condition that affects the cells of bone tissue. There are no specific clinical signs or imaging manifestations in the early stages of the disease, making it simple to overlook and misdiagnose. Because of the disease's rarity, there is presently no standardized treatment principle. There are few accounts of such occurrences affecting the axis among children. We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone. CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation, a 6-year-old boy was brought to our hospital. Following a careful evaluation, the pathology indicated a strong likelihood of an axial EG. Ultimately, we decided to treat the boy with posterior pedicle screw fixation and local steroid injections. CONCLUSION EGs of the upper cervical spine are quite uncommon in children, and they are exceedingly easy to overlook or misdiagnose. Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.
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Affiliation(s)
- Cheng-Quan Tu
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Zhi-Da Chen
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Xiao-Tao Yao
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Yuan-Jie Jiang
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Bi-Fang Zhang
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Bin Lin
- Department of Orthopedic Surgery, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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Alzahem T, Alkatan HM, Maktabi AM, Alsulaiman N, Cruz AAV. Ophthalmic histiocytic lesions (diseases of the L group): A multicenter clinicopathological study of 18 cases and review of literature. Eur J Ophthalmol 2023; 33:556-566. [PMID: 35816372 DOI: 10.1177/11206721221113431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/11/2023]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD) are rare histiocytic disorders in the L (Langerhans) group diseases. They range from self-limited benign diseases to lethal disseminated forms. METHODS This retrospective study was conducted in 3 tertiary hospitals in Saudi Arabia and Brazil. Histopathological records were searched for all patients diagnosed with ocular and periocular histiocytic disorders from January 1993 to December 2018. Histopathological slides and medical files were reviewed for data collection and simple analysis of demographics, clinical manifestations, and management. The relevant literature is reviewed. RESULTS Twenty-two eyes of 18 patients with biopsy-proven histiocytic disorders in the L group were included. Female-to-male ratio was 1.25:1. Average age at presentation was 14 years (range, 1-54). LCH was diagnosed in 14 eyes, while eight eyes had ECD. All LCH cases were unilateral and confined to the bone as cases of eosinophilic granuloma (EG), while patients with ECD were bilateral. Commonest presentations in EG and ECD were eyelid swelling (85.7%) and periocular xanthomas (75%), respectively. Orbit was involved in 100% of EG cases, with bony erosion in 54.5%. Relevant systemic involvement was found in 100% of ECD and 21% of EG cases. Surgical intervention was needed in 16 of the 22 eyes (72.7%). All EG and 25% of patients with ECD required surgical excision. CONCLUSIONS Histiocytic disorders are a rare group of diseases, including the L group. Relevant systemic associations require specific and selective therapy. A high clinical index and multidisciplinary collaboration are essential for the proper evaluation and management of these patients.
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Affiliation(s)
- Tariq Alzahem
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, 37850King Saud University, Riyadh, Saudi Arabia.,Pathology and Laboratory Medicine Department, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Azza My Maktabi
- Pathology and Laboratory Medicine Department, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Naif Alsulaiman
- Oculoplastics Division, 46670King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Antonio Augusto V Cruz
- Ophthalmology Department, 42496School of Medicine of Ribeirão-Preto, University of São Paulo, São Paulo, Brazil
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Gami A, Schilling A, Ehresman J, Sciubba DM. Benign Brain and Spinal Tumors Originating from Bone or Cartilage. Adv Exp Med Biol 2023; 1405:457-476. [PMID: 37452949 DOI: 10.1007/978-3-031-23705-8_17] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign osseocartilaginous tumors of the spine are overall uncommon, representing between 1 and 13% of all primary bone tumors and less than 10% of all spinal tumors. Tumors in this category include osteoblastic lesions such as the related osteoid osteoma and osteoblastoma, and cartilage-forming lesions including osteochondroma, chondroma, and chondroblastoma. Aneurysmal bone cysts, giant cell tumors of bone, and eosinophilic granulomas also comprise benign tumors of the spine arising from bone. There is significant heterogeneity in the epidemiology, molecular biology, imaging features, and optimal treatment of these lesions. For example, osteoid osteoma is characterized by high expression of the cyclooxygenase enzymes, making it amenable to treatment with anti-inflammatory drugs initially, whereas other lesions such as osteoblastoma may require intralesional curettage or en bloc resection sooner. Generally, en bloc resection is preferred when possible to minimize risk of recurrence. Further, some tumors may arise in the setting of syndromic conditions, such as multiple chondromas arising in Ollier disease or Maffucci syndrome, or as part of genetic disorders, such as osteochondromas in the context of hereditary multiple exostosis. These lesions may present with local pain, cause neurological compromise or be discovered incidentally on routine imaging. The Enneking classification and Weinstein-Boriani-Biagini system are routinely used to classify lesions and assist in surgical planning. More novel techniques such as radiofrequency ablation and laser photocoagulation have been applied for the treatment of osteoid osteoma and may have utility in the treatment of other lesion types. A multidisciplinary approach is critical in the management of benign lesions of the spine, and both chemotherapeutic and surgical approaches are routinely used.
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Affiliation(s)
- Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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6
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Alarcón-Jaramillo J, Moreno-Arango I, Márquez JC. Acquired butterfly vertebra as a sequela of eosinophilic granuloma. Skeletal Radiol 2022. [PMID: 36520219 DOI: 10.1007/s00256-022-04249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/21/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Butterfly vertebras are an abnormal embryological formation of the spinal bodies that occur because of a lack of fusion of the chondrification centers of the vertebral bodies. Langerhans cell histiocytosis is an entity that frequently involves vertebral bodies resulting in flat vertebras, and recovery of the vertebral body height is a very unusual finding. We present a case report of a pediatric patient with a thoracic acquired butterfly vertebra which occurred secondary to a Langerhans cell histiocytosis involvement. It is extremely rare to find vertebra plana that regains its complete height but is even more infrequent to evidence of a butterfly vertebra deformity that is not congenital.
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Jain M, Parija D, Padhi S, Naik S. Eosinophilic Granuloma as a Solitary Lytic Lesion of the Cervical Spine in a Child. J Orthop Case Rep 2022; 12:61-64. [PMID: 36687482 PMCID: PMC9831226 DOI: 10.13107/jocr.2022.v12.i08.2966] [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: 04/22/2022] [Revised: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Eosinophilic granuloma (EG) is a type of Langerhan cell histiocytosis (LCH) with unknown etiology. This benign tumorous lytic lesion affects mainly children or young adults, causing bone destruction. Although, the flat or the long bones are commonly affected, localized spinal involvement in pediatric age group is rare. A thorough workup is therefore necessary for this condition, which may mimic other severe conditions. Case Report A 10-year-old girl presented with neck pain for 4 months without any history of trauma, fever, or neurological weakness. An X-ray revealed radiolucency and sclerosis of the fifth cervical vertebral body, which was hypointense on T1 and heterogeneous on T2-weighted image, with mild peripheral enhancement on fat-suppressed post-contrast T1-weighted image. Biopsy histomorphology revealed a lymphohistiocytic lesion with scatted histiocytes with grooved nuclei, immunopositive for Langerin; thus consistent with LCH (EG). She was managed conservatively with a completely pain free course with full range of movement at 1-year follow-up. Her follow-up X-ray showed complete remodeling and ongoing fusion. Conclusion EG should be considered as a differential diagnosis in the evaluation of solitary lytic lesion involving spine in pediatric age group. This, although self-resolving, may occasionally need surgical intervention with or without adjuvant therapy.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha India,Address of Correspondence: Dr. Mantu Jain, Department of Orthopedics, All India Institute of Medical Sciences, 102/J, Cosmopolis, Dumduma, Bhubaneswar, Odisha, India. E-mail:
| | - Debasish Parija
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha India
| | - Somanath Padhi
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Astigarraga I, García-Obregón S, Pérez-Martínez A, Gutiérrez-Carrasco I, Santa-María V, Iturrate CR, Reggiori ML, Carrillo TM, Torrent M; Grupo de Histiocitosis de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP). Langerhans cell histiocytosis. Advances in pathogenesis and clinical practice. An Pediatr (Barc) 2022:S2341-2879(22)00148-X. [PMID: 35869015 DOI: 10.1016/j.anpede.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a type of myeloid neoplasia that can affect different organs or tissues and exhibits substantial variability in its clinical presentation and biological behaviour, so it may mimic different diseases. Performance of different clinical assessments and laboratory and imaging tests is recommended to determine the extent of involvement, which may be of a single location or multisystemic, and the presence or absence of dysfunction in risk organs, such as the haematopoietic system, liver and spleen. The diagnosis must be confirmed by histological examination of a biopsy sample. Molecular tests have identified mutations in the mitogen-activated protein kinase (MAPK) pathway, which has expanded treatment options. The diagnosis is complex and there is controversy regarding the management of certain cases. Treatment recommendations depend on the location of the lesions and the extent of involvement. International collaborative studies have demonstrated the effectiveness of prolonged combination therapies such as vinblastine and prednisone in severe or multisystemic forms, and anti-inflammatory drugs such as indomethacin and other cytostatic combinations have proven beneficial. Langerhans cell histiocytosis is a good example of the importance of precision medicine and the benefit of identifying molecular targets, common to different neoplasms, to develop new therapies. MAPK pathway inhibitors offer an alternative treatment option in refractory cases and neurodegenerative forms of LCH. Molecular testing can contribute to the prognosis, treatment and follow-up of LCH, especially in severe forms of disease.
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Dukmak ON, Abualia SM, Meqbil YJ, Emar M, Basal SI, Itaidek S. Eosinophilic granuloma affecting the parietal bone of the skull: A case report and literature review. Int J Surg Case Rep 2022; 96:107371. [PMID: 35780646 PMCID: PMC9284054 DOI: 10.1016/j.ijscr.2022.107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/22/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The rare form and mildest variant of Langerhans cell histiocytosis is eosinophilic granuloma (EG). In the clinical presentation, EG can be monostotic, polyostotic, or can encompass many organs. The parietal bone is the most common location of the skull bones that are affected by EG. So far, there have been no reported cases of EG with skull odor as an unexplained presentation. CASE PRESENTATION An 8-year-old girl presented with a 4 months history of a right parietal bone swelling of the skull with an offensive odor. There was no discharge and no history of vomiting or trauma. An MRI scan of the brain showed swelling with a bone lesion of the right parietal bone. Infection was the source of the swelling and the bad odor. Treatment was done by surgical excision of the lesion. CONCLUSION EG has a variety of presentations and should be suspected when tenderness and local swelling are present. Radiography was found to be helpful in the diagnosis and surgical treatment was done to manage the case.
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Affiliation(s)
- Osama N. Dukmak
- Al-Quds University - Faculty of Medicine, Jerusalem, State of Palestine,Corresponding author.
| | | | - Yara J.I. Meqbil
- Al-Quds University - Faculty of Medicine, Jerusalem, State of Palestine
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10
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Moriel-Garceso DJ, González-Quevedo D, García de Quevedo D, Tamimi I. Three-dimensional printed titanium pseudo-prosthesis for the treatment of a tumoral bone defect. JSES Rev Rep Tech 2022; 2:81-86. [PMID: 37588280 PMCID: PMC10426679 DOI: 10.1016/j.xrrt.2021.09.002] [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] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - David González-Quevedo
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
| | | | - Iskandar Tamimi
- Department of Orthopaedic Surgery, Regional University Hospital of Malaga, Malaga, Spain
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Alkatan HM, Alzahem TA, Maktabi AMY. Ophthalmic histiocytic lesions: a baseline demographic and clinicopathological study of 28 cases from two eye centers. Int Ophthalmol 2021; 42:1221-1232. [PMID: 34727265 DOI: 10.1007/s10792-021-02108-1] [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: 02/14/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ophthalmic histiocytic lesions comprise a heterogeneous rare group of disorders that are characterized by an abnormal proliferation of histiocytes and may affect all age groups of both sexes. The aim of this study was to highlight the basic demographic, clinical, and histopathological characteristics of this rare group of diseases in ophthalmic practice, which has not been previously studied in this area. Only individual cases have been previously reported. METHODS This was a retrospective study of all biopsied ocular and periocular histiocytic lesions from two centers, King Khaled Eye Specialist Hospital (KKESH) and King Abdulaziz University Hospital (KAUH) in Riyadh, Saudi Arabia, from January 1993 to December 2018. The histopathological diagnosis was confirmed, and the cases were re-classified by reviewing all histopathological slides. The corresponding demographic and clinical data were analyzed. A relevant literature review was also carried out for comparison of our collected analyzed data to published data and to draw our own conclusions. RESULTS A total of 34 ocular/periocular histiocytic lesions in 28 patients who were mostly Saudis (92.9%) were included. The male-to-female ratio was 4:3. The median age at presentation was 6.4 years (range: 2.8-35 years). Twenty-two patients had unilateral involvement, and six patients had bilateral lesions. In patients with Langerhans cell histiocytosis (LCH; L group), the most common presenting findings were eyelid swelling (75%), periocular tenderness (37.5%), proptosis/globe displacement (37.5%) eyelid erythema (25%), and orbital pain (12.5%). In patients with Rosai Dorfman disease (RDD; R group), proptosis/globe displacement occurred in all patients and 80% had decreased vision. Patients in the C group (Cutaneous non-LCH histiocytoses) had variable clinical features because of the different locations of the histiocytic lesions, with the majority involving the eyelids (66.7%). Diagnosis was accurately reached clinically in 38.8%, 33.7%, and 46.7% of patients in the L, C, and R groups, respectively. Overall, the clinical diagnosis was in concordance with the histopathologic diagnosis in 14 out of 34 lesions (41.2%). CONCLUSIONS Histiocytic disease is more likely to be overlooked clinically owing to its rarity. In the C group, juvenile xanthogranuloma (JXG) was the most commonly encountered histiocytic lesion and had a tendency to present at a later age with extremely rare intraocular involvement in contrast to previously published reports. The median age at presentation was higher in group R. All patients in group L had strictly unilateral disease, while RDD (group R) was most commonly bilateral. Future research on genetic aspects, management, and prognosis is necessary.
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Affiliation(s)
- Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia. .,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. .,Pathology and Laboratory Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Tariq A Alzahem
- Ophthalmology Department, College of Medicine, King Saud University, P.O. Box: 266, Riyadh, 11362, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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12
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Namikawa T, Marui A, Yokota K, Yamaguchi S, Fukudome I, Uemura S, Munekage M, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Gastric Eosinophilic Granuloma Related to Anisakiasis Resected by Laparoscopic and Endoscopic Cooperative Surgery. Cancer Diagn Progn 2021; 1:507-512. [PMID: 35403157 PMCID: PMC8962874 DOI: 10.21873/cdp.10068] [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: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Anisakiasis-related gastric eosinophilic granuloma is rare. CASE REPORT Herein, we report a patient with anisakiasis-related gastric eosinophilic granuloma who was treated with laparoscopic and endoscopic cooperative surgery (LECS). A 59-year-old woman was presented to our hospital for further examination of a gastric lesion that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed a submucosal tumor-like lesion in the lower body of the stomach. Endoscopic ultrasonography showed a heterogeneous hypoechoic submucosal mass lesion in the submucosal layer measuring 10 mm, without evidence of deep involvement. Under a clinical diagnosis of gastrointestinal stromal tumor, the patient underwent LECS. Gross appearance of the resected specimen revealed a 1.5×1.0 cm submucosal tumor-like lesion. Microscopic examination revealed necrosed insects consistent with the characteristics of gastric anisakiasis, around which prominent eosinophilic infiltration and granulomas were observed. This prompted a diagnosis of gastric eosinophilic granuloma related to anisakiasis. CONCLUSION To the best of our knowledge, this is the second case of gastric eosinophilic granuloma related to anisakiasis resected by LECS in the English medical literature. LECS might be a useful procedure for minimally invasive therapeutic diagnosis.
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Affiliation(s)
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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13
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Pires T, Duarte Santos C, Gonzalez Santos M, Luz L, Ferrão A, Banza MJ. Eosinophilic Granuloma: A Rare and Often Benign Condition Presenting as a Lump on the Head, which was Easily Treated. Eur J Case Rep Intern Med 2021; 8:002727. [PMID: 34377705 DOI: 10.12890/2021_002727] [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: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
Eosinophilic granuloma is a localized, non-invasive form of Langerhans cell histiocytosis. It usually develops in the long bones and is more frequent in children under the age of 10 years. It is very rare in adults. We present the case of a young woman admitted to hospital for persistent refractory left parietal headache, later revealed to be caused by an eosinophilic granuloma. LEARNING POINTS Eosinophilic granuloma is a localized benign form of Langerhans cell histiocytosis.It is essential to exclude the presence of bone lesions in other locations and/or systemic involvement.The prognosis is good, with surgical resection, when necessary, being a curative intervention, although sometimes (as in this case) a conservative approach is sufficient.
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Affiliation(s)
- Tatiana Pires
- Department of Internal Medicine, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | | | - Luis Luz
- Department of Internal Medicine, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Ana Ferrão
- Department of Internal Medicine, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Maria J Banza
- Department of Internal Medicine, Centro Hospitalar de Leiria, Leiria, Portugal
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Faustino ISP, Fernandes PM, Pontes HAR, Mosqueda-Taylor A, Santos-Silva AR, Vargas PA, Lopes MA. Langerhans cell histiocytosis in the oral and maxillofacial region: An update. J Oral Pathol Med 2021; 50:565-571. [PMID: 34091963 DOI: 10.1111/jop.13207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation and infiltration of histiocytic cells. METHODS This review focused on the main aspects associated with LCH. RESULTS LCH can involve single or multiple organs and systems, with bone and skin being the most commonly affected sites. Regarding skeletal manifestations, the jawbones are involved in about 20%-30% of all cases. Such lesions may present as unilocular or multilocular images mainly affecting the posterior mandible. Oral soft tissue lesions may also occur, with the gingiva and hard palate being the most frequently affected sites. CONCLUSION The diagnosis and management of LCH are challenging, requiring a multidisciplinary approach, with dentists playing a central role since oral manifestations can be the first sign of the condition.
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Affiliation(s)
| | - Patrícia Maria Fernandes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Moyano CA, Remondino RG, Tello CA, Piantoni L, Galaretto E, Francheri Wilson IA, Bersusky E, Noël MA. Histiocytosis in the pediatric spine: a clinical and radiographic analysis of 50 patients. Spine Deform 2021; 9:823-31. [PMID: 33400235 DOI: 10.1007/s43390-020-00261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Descriptive, retrospective. Scientific level of evidence IV. OBJECTIVES The aim of this study was to evaluate a consecutive case series of 50 pediatric patients with LCH of the spine. Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans cells in different organs. Incidence in children range from 2 to 10 cases per million. In the current literature, few series evaluate LCH in the pediatric spine. MATERIAL AND METHODS A consecutive case series of 50 pediatric patients with LCH of the spine treated at our hospital between 1984 and 2016, with a follow-up of at least 2 years, was analyzed. Sex, age, clinical and radiographic presentation, number of lesions, treatment, complications, and outcome were assessed. RESULTS Fifty patients, 26 boys and 24 girls, were evaluated. Mean age was 5 years and 2 months (6 months to 13 years and 3 months). 27 patients had a single spinal lesion while 23 had 2 or more lesions. A total of 100 vertebrae were involved. The thoracic spine was the most affected. The most frequent lesion location was in the vertebral body in 88% of the cases. The symptoms were pain (87%), reduced range of motion, deformity, and neurologic deficit. Biopsy was performed in 48 patients. Thirty-nine patients received medical treatment, 28 used orthoses and six required surgery. Six patients (12%) recurred at a mean of 3 years and 5 months (range 2-12 years). In all cases, neurological symptoms, torticollis, and deformities resolved after medical or surgical treatment. CONCLUSIONS Because of the variable presentation of the disease, ranging from a solitary isolated vertebral lesion to polyostotic and multisystemic involvement, a multidisciplinary team is required to have an adequate management of these patients and to obtain good results.
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Tripathi M, Maskara P, Deora H, Bansal D, Mohindra S, Tripathi S, Kaur R, Sheehan JP, Rana R, Kumar N. Role of Stereotactic Radiosurgery in Intracranial Histiocytosis: a Systematic Review of Literature of an Emerging Modality for Localized Disease. World Neurosurg 2021; 150:64-70. [PMID: 33744421 DOI: 10.1016/j.wneu.2021.03.047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A histiocytosis is a group of immunoproliferative disorders of clonal cells. The management protocols are still evolving, with chemotherapy as the mainstay of treatment. OBJECTIVE This study aims to evaluate the feasibility, safety, efficacy, and complication profile of stereotactic radiosurgery for intracranial histiocytosis. METHODOLOGY The authors reviewed PubMed, Scopus, Web of Science, and Embase for "radiosurgery" and "histiocytosis" in the English/Japanese language following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The patient profile, radiosurgical parameters (dose and isodose), target volume, and mode of radiosurgery (Gamma knife, LINAC radiosurgery, etc.) were collected. Its use as primary or adjuvant therapy, clinical and radiological outcome was also evaluated. RESULTS We identified 7 studies (9 patients); mean age: 41.9 years (24-57 years). Six patients received Gamma-knife radiosurgery, whereas 3 received CyberKnife radiosurgery. The Langerhans cell histiocytosis variants were eosinophilic granuloma in 3, whereas 4 were not defined. Two cases had Rosai-Dorfman disease, and 2 different yet pathogenetically related histiocytic disorders. Four patients harbored lesions in the pituitary stalk and posterior pituitary, 2 patients in the petrous region, 1 patient had a pontine lesion, and 2 patients had multiple lesions. The dose delivered ranged from 8 to 28 Gy. A total of 18 lesions (9 patients) were followed for 81.67 patient-years: 7 (39%) disappeared, 8 (44.4%) showed radiological reduction, and 2 (11%) remained stable. One lesion (5%) showed an increase in size needed surgical excision. There were no adverse effects. CONCLUSION The role of stereotactic radiosurgery needs to be further evaluated as the current cohort with only 9 cases (2 are Rosai-Dorfman disease) is insufficient to make conclusions. It may be a viable alternative in localized disease, along with chemotherapy and targeted surgery.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
| | - Prasant Maskara
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Deepak Bansal
- Hematology/Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Rupinder Kaur
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ruchita Rana
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiation Therapy, Postgraduate Institute of Medical Education and Research, Chandigarh.
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Chugh A, Kaur A, Kumar Patnana A, Kumar P, Chugh VK. Unisystem Langerhans cell histiocytosis in maxillofacial region in pediatrics: comprehensive and systematic review. Oral Maxillofac Surg 2021; 25:429-444. [PMID: 33591444 DOI: 10.1007/s10006-021-00949-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 10/08/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The study aimed to identify, enlist, and analyze cases of unisystem LCH in the maxillofacial pediatric population to understand the clinical presentation and encourage the consideration of this rare disease in the differential diagnosis. Langerhans cell histiocytosis (LCH) is an aggressive benign condition affecting mainly the pediatric population. It can be easily masked as periodontal disease in the maxillofacial region. Early diagnosis and a systemic evaluation are of utmost importance. METHODOLOGY We are presenting a complete review of literature in the pediatric population according to PRISMA guidelines for clinicopathologic, histopathological, immunohistochemistry, and treatment for unisystem LCH. The risk of bias assessment across studies was done using a Case series appraisal checklist by Guo et al. 53 RESULTS: Forty-nine articles (152 cases) were selected which met our inclusion and exclusion criteria to be included in our review. Most of the patients fall in 6-12 years of age with the involvement of the mandibular body region in 40.79% cases. This disease mainly presents as erythematous gingiva, pain, swelling, and mobile teeth. Management can range from minimal intervention to chemotherapy and surgery. CONCLUSION AND PRACTICAL IMPLICATIONS Although this is a rare condition, it should be considered especially in the pediatric population with periodontitis type lesions and floating teeth and comprehensive management should be followed. Early diagnosis of the disease is very important.
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Affiliation(s)
- Ankita Chugh
- Oral and maxillofacial surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amanjot Kaur
- Oral and maxillofacial surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Arun Kumar Patnana
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Foster KW, Robinson SK, Tung-Hahn E, Gibbons G, Cruse CW, Mudaliar K, Tung R, Kim W. Multifocal Langerhans Cell Histiocytosis: A Unique Presentation of Eosinophilic Granuloma with Intracranial Extension, Massive Lymphadenopathy, and Epstein-Barr Viral Infection in an Adolescent Female. Case Rep Dermatol 2021; 13:28-35. [PMID: 33613231 PMCID: PMC7879306 DOI: 10.1159/000511488] [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: 07/11/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
We report the case of an otherwise healthy 17-year-old female who presented for surgical removal of an enlarging “atypical cyst” on her scalp. During subtotal excision, only friable serosanguinous translucent ribbons of tissue were found. A histopathologic diagnosis of Langerhans cell histiocytosis (LCH) was rendered and imaging studies revealed extradural invasion of the tumor. Within weeks, the patient also developed progressive lymphadenopathy with grossly elevated levels of Epstein-Barr virus viral capsid antigen antibody levels. This report aims to highlight a unique presentation of LCH with discussion of workup, management, and avoidance of potential surgical complications.
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Affiliation(s)
- Kent Wade Foster
- Department of Biology, Brigham Young University, Provo, Utah, USA
| | - Shamika Kayo Robinson
- Division of Dermatology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Eleanor Tung-Hahn
- Department of Public Health, The University of South Florida, Tampa, Florida, USA
| | | | - Carl Wayne Cruse
- Cutaneous Oncology Program, Moffitt Cancer Center, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kumaran Mudaliar
- Department of Pathology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida, USA
| | - Wendy Kim
- Division of Dermatology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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19
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Abstract
Background Acetabular roof lesions (ARLs) in children are uncommon and may involve a variety of diseases. The acetabular roof is the main weight-bearing area of the hip joint, and lesions affecting the acetabular roof lead to fluid accumulation in the hip joint, causing hip pain and claudication. Methods for diagnosing and treating ARLs and the prognosis after treatment are rarely reported. We present our experience in a group of children and teenagers with ARLs to retrospectively explore the clinical and imaging features and histopathological diagnosis and report the treatment methods and follow-up observations. Methods Patients with ARLs admitted to the Children’s Hospital of Chongqing Medical University from April 2011 to September 2018 were selected retrospectively. We collected the basic information of patients (name, sex, age), main symptoms and signs, results of various laboratory tests, treatment methods, and intraoperative observations through the hospital medical record system. We collected X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and pathological examination data through the Picture Archiving and Communications System. Follow-up data were collected through an outpatient medical record system, telephone, and chat software (such as WeChat). We used descriptive methods to analyze the lesion structure and destruction mode based on the imaging findings and histopathological diagnosis. Results There were 14 ARL patients, including 6 with eosinophilic granuloma (EG), 5 with chronic osteomyelitis, 2 with bone cyst, and 1 with tuberculosis. One patient underwent percutaneous needle biopsy, 2 underwent open biopsy, and 11 underwent curettage; among them, 5 patients also underwent bone grafting. These lesions had no characteristic imaging findings, and the diagnosis was mainly based on histopathological examination. Most patients showed complete symptom resolution and good hip function at the 1-year follow-up. Conclusion ARLs are not common in children. The types of lesions are diverse and mostly benign, with EG being most common. Malignant tumors may also occur, such as Ewing’s sarcoma, non-Hodgkin’s lymphoma, metastases and neuroblastoma. CT and MRI can be helpful in diagnosing certain cases, but incisional biopsy is required in most cases.
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Affiliation(s)
- Jinkui Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Zhongliang Wang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China. .,Children's Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Jiaqiang Qin
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, 2 ZhongShan Rd, ChongQing, 400013, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Children's Hospital of Chongqing Medical University, Chongqing, PR China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.,Children's Hospital of Chongqing Medical University, Chongqing, PR China
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20
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Chen J, Li J, Yang YJ, Tian XP, Zeng XF. [Clinical and prognostic characteristics in patients with eosinophilic granulomatosis with polyangitis]. Zhonghua Nei Ke Za Zhi 2020; 59:360-365. [PMID: 32370464 DOI: 10.3760/cma.j.cn112138-20191111-00742] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the clinical and prognostic characteristics in patients with eosinophilic granulomatosis with polyangitis (EGPA). Methods: The clinical data of 146 EGPA patients hospitalized in Peking Union Medical College Hospital from 2000 to 2019 were analyzed retrospectively, including clinical manifestations, laboratory results, treatment, complications and outcome at discharge. Birmingham Vasculitis activity score-V3 (BVAS-V3) was used to evaluate disease activity. Results: The ratio of male to female was 1.8∶1 with average age (41.7±16.1) year-old. The median time from disease onset to diagnosis was 18(6, 60) months (0.5~450). The most common clinical manifestations were lung [121(82.9%)] and nose/paranasal sinuses [119(81.5%)] involvement. The positive rate of anti-neutrophil cytoplasmic antibody (ANCA) was 24.7%, mainly peripheral (P)-ANCA/myeloperoxidase (MPO)-ANCA. Compared with ANCA-negative patients, the ANCA-positive patients had a higher incidence of renal involvement and nervous system involvement (66.7% vs. 20.9%, 80.6% vs. 51.8%, P<0.001), fever and optic neuropathy (66.7% vs. 40.9%,8.3% vs. 0, P<0.05), more active disease [median BVAS-V3 25(18,30)vs. 19(14,24),P=0.001] and more elevated erythrocyte sedimentation rate [40.5(20.5,82.8)mm/1h vs. 25.0(13.3,50.8)mm/1h,P=0.006] and C-reactive protein [37.1(11.8,72.9)mg/L vs.13.5(3.4,66.1)mg/L,P=0.036]. More ANCA-negative patients had pleural effusion (20.9% vs. 5.6%, P<0.04) compared with ANCA-negative patients. Pulmonary infection was the most common complication. A total of 12 EGPA patients (8.2%)achieved remission and 6 patients (4.1%)died or discharged themselves from the hospital. Conclusion: EGPA is a rare small vessel vasculitis. The clinical manifestations and outcomes are heterogenous. The mortality rate of EGPA is high.
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Affiliation(s)
- J Chen
- Department of Rheumatology, Peking Union Medical College Hospital, Nation Clinical Research Center for Dermatologic and Rheumatologic Diseases of China, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J Li
- Department of Rheumatology, Peking Union Medical College Hospital, Nation Clinical Research Center for Dermatologic and Rheumatologic Diseases of China, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y J Yang
- Department of Rheumatology, Peking Union Medical College Hospital, Nation Clinical Research Center for Dermatologic and Rheumatologic Diseases of China, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X P Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Nation Clinical Research Center for Dermatologic and Rheumatologic Diseases of China, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X F Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Nation Clinical Research Center for Dermatologic and Rheumatologic Diseases of China, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Desbarats C, Adnot J, Bastien AV, Trost O. [Langerhans cell histiocytosis revealed by a temporomandibular joint disorder: Report of a case and review of the craniofacial expressions]. Rev Med Interne 2019; 41:50-53. [PMID: 31474430 DOI: 10.1016/j.revmed.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/03/2019] [Revised: 07/17/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Langerhans cell histiocytosis (HL) is a rare disease that can affect all tissues. Oral manifestations such as mucosal ulcer and tooth mobility are often the first signs of the disease. We report a rare case of mandibular condyle unifocal HL mimicking a temporomandibular joint disorder. CASE REPORT A 44-year-old patient presented with a left temporomandibular disorder with painful left preauricular swelling. The imaging assessment found a bone lesion of the left mandibular condyle. A curettage with biopsy was used to diagnose HL. Six months later, the patient had no more pain. DISCUSSION The craniofacial clinical expressions of HL mainly concern the bones, which can cause: pain, swelling, fracture, compression of noble organs. The other sites are: oral cavity, skin, lymph nodes, or eyes. Isolated forms are generally benign, and their treatment is discussed between abstention and non-aggressive surgery.
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Affiliation(s)
- C Desbarats
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - J Adnot
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - A V Bastien
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - O Trost
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalo-universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France; Laboratoire d'anatomie, faculté de médecine de Rouen, 22, boulevard Gambetta, 76000 Rouen, France; Institut national de la santé et de la recherche médicale (Inserm), LIMICS UMR-1142, 76000 Rouen, France.
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Zhang X, Jiao Y. The clinicopathological characteristics of Kimura disease in Chinese patients. Clin Rheumatol 2019; 38:3661-3667. [PMID: 31440918 DOI: 10.1007/s10067-019-04752-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/19/2019] [Accepted: 08/15/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Kimura disease (KD) is a rare idiopathic inflammatory disorder of unknown etiology. Unusual presentations of KD might cause diagnostic difficulty or be misdiagnosed as malignancy if clinical suspicion is insufficiently high. Here, we aimed to determine the clinicopathological features of Chinese KD patients to reveal further insights into the natural history and treatment of this disease. METHOD The clinical data of 46 cases of KD diagnosed at Peking Union Medical College Hospital from January 1980 to December 2018 were analyzed retrospectively through case record review. RESULTS Of 46 cases, 40 were male and six were female. The age at onset ranged from 2 to 56 years (median 27 years). All patients presented with either single (26.1%) or multi-focal (73.9%) subcutaneous masses. Twenty-nine (63.0%) cases presented with head and neck subcutaneous masses, and 9 cases (19.6%) involved different parts of the body. Parotid, submandibular, and lacrimal gland involvement occurred in 17 (37.0%), 3 (6.5%), and 2 cases (4.3%), respectively. Nephrotic syndrome was present in three cases (6.5%), and thromboembolism was present in five cases (10.9%). During follow-up, thirteen patients (13/28, 46.4%) relapsed over 1-13 years (median 8.5 years). The recurrence rate in patients receiving corticosteroids, surgery, and combined surgery and radiotherapy was 30.8%, 66.7%, and 50.0%, respectively. One patient was diagnosed with T cell lymphoma 1 year after diagnosis of KD. CONCLUSIONS KD is characterized by subcutaneous masses but it is also a systemic disease. Given the high rate of recurrence and reported association with lymphoma, patients require careful long-term follow-up.Key Points• Kimura disease (KD) is a rare inflammatory disorder of unknown etiology that is endemic in Asia.• Clinicians must regard and manage KD as a systemic disease.• There is no consensus on optimal treatments and further studies are necessary to improve outcomes.• Given the high rate of recurrence and reported association with lymphoma, patients require careful long-term follow-up.
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Affiliation(s)
- Xuehan Zhang
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing St., Beijing, 100730, China.
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Higuera-Cárdenas JM, Román-Matus A, Martínez-Contreras AM, Haro-Acosta ME. [Histiocitosis de Langerhans en el cráneo. Informe de un caso]. CIR CIR 2019; 87:96-100. [PMID: 30600810 DOI: 10.24875/ciru.18000330] [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: 11/17/2022]
Abstract
Background Langerhans cell histiocytosis is a rare disease in the adult, predominates in the pediatric age and is more common in men than in women. The sites of greater affection are the long bones, followed by the bones of the skull. Patients usually have symptoms related to the site of affection, usually polyostotic lesions, monostotic lesions occur less frequently. The study of choice and treatment depends on the site affected, in the skull the main one is the magnetic resonance and the treatment is the surgical excision of the lesion. Clinical Case A 29-year-old female patient who entered the hospital due to a non-painful, rapidly growing, progressive tumor on the frontal region of the skull. Physical examination revealed a rounded mass of approximately 5 cm in diameter in the left, non-painful, non-painful, left-frontoparietal region. Magnetic resonance imaging of the skull showed a lytic lesion in the frontal bone. It was surgically excised with clean edges; titanium plate was placed. Histopathological diagnosis was histiocytosis of Langerhans cells. Conclusions It is a rare case, with a patient of an uncommon age of presentation, absence of metastasis by means of study protocol and due to the monostotic presentation improves the prognosis for this patient.
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Affiliation(s)
| | - Alexis Román-Matus
- Hospital General de Zona 30. Instituto Mexicano del Seguro Social, Baja California, México
| | | | - María E Haro-Acosta
- Delegación Baja California. Instituto Mexicano del Seguro Social, Baja California, México
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Nangalia R, Chatterjee RP, Kundu S, Pal M. Langerhans Cell Histiocytosis in an Adult with Oral Cavity Involvement: Posing a Diagnostic Challenge. Contemp Clin Dent 2019; 10:154-157. [PMID: 32015659 PMCID: PMC6974994 DOI: 10.4103/ccd.ccd_432_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 12/19/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare hematological disorder characterized by local or generalized, uncontrolled proliferation and infiltration of Langerhans type of histiocytic cells. It represents a spectrum of clinicopathologic disorders, ranging from a highly aggressive and frequently fatal multisystem disease to an easily cured solitary lesion of bone. Involvement of children and the younger age group is more common than the adults. Oral cavity involvement occurs early in LCH, but the initial symptoms are generally nonspecific, often causing misdiagnosis. This report describes a rare case of chronic localized LCH in an adult patient, with involvement of oral cavity. A 34-year-old male patient presented with multiple nodulo-papular, ulcerated lesions in gingiva involving both the jaws (primarily mandible) and the left buccal mucosa, in addition to regional teeth mobility. The most striking feature was that even after extraction of mobile teeth, the lesions persisted. After recording proper history, performing clinical and radiological evaluation, an incisional biopsy was performed followed by histopathology and immunohistochemistry to reach a confirmatory diagnosis of LCH, thereby implementing early and appropriate initiation of treatment.
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Affiliation(s)
- Richa Nangalia
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | | | - Sanchita Kundu
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
| | - Mousumi Pal
- Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
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Wang RQ, Shi J, Niu FN, Tang M, Fan XS, Qiu YD, Chen J. [Visceral parasitic migration of liver: a clinicopathologic analysis of seven cases]. Zhonghua Bing Li Xue Za Zhi 2018; 47:710-713. [PMID: 30220127 DOI: 10.3760/cma.j.issn.0529-5807.2018.09.012] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical, radiological and pathological features of visceral parasitic migration of the liver. Methods: Seven cases of visceral parasitic migration of liver were identified at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to July 2017. Clinical data, enhanced CT image and pathological features were analyzed, combining with literature review. Results: There were 5 male and 2 female patients. Five patients presented with abdominal pain or discomfort as the first symptom. Two patients were admitted to the hospital for physical examination with liver nodule. Blood eosinophils were mildly to moderately increased in 4 cases. Enhanced CT showed the liver irregular beaded nodules that showed no significant enhancement of arterial phase. Mild enhancement of round lesions (ring lesion) was seen in a few cases before surgery. By histopathology, the lesions showed central geographic necrosis, surrounded by epithelioid granuloma and inflammatory cell bands. A large number of eosinophils and scattered multinucleated giant cells were found, especially at the peripheral of the lesion. Charcot-Leyden crystals were present in all case and parasitic migrans was found in one case. Conclusions: Visceral parasitic migration of liver is a rare liver disease and is easily misdiagnosed as other benign or malignant liver tumors. Combining clinical data, enhanced CT images and pathological examination can improve the preoperative and postoperative diagnosis of the disease.
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Affiliation(s)
- R Q Wang
- Department of Pathology, the Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing 210008, China
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Kocak T, Ulmar B, Reichel H, Weckbach S. Eosinophilic granuloma of the spine involving C1 and pulmonary infiltration in young children - Presentation of two cases with a follow-up over 10 years including review of the literature. J Orthop 2018; 15:808-811. [PMID: 30147276 DOI: 10.1016/j.jor.2018.08.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives The incidence of spinal eosinophilic granuloma in children is low. Methods Clinical case presentation of two children (♀ 18 months old, ♂ 16 months old) complaining of acute torticollis. Follow-up period was 11 years in the female patient and 13 years in the male patient. Results The diagnostics certified a spinal eosinophilic granuloma: the girl had a multilevel spinal disease including the atlas, the boy a thoracic and pulmonary manifestation. Both were treated with chemotherapy with good clinical results. Conclusions Overall, the above described is a very rare clinical entity. However, persisting torticollis in children should be clearly diagnosed.
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Affiliation(s)
- Tugrul Kocak
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Benjamin Ulmar
- Neuenbürg Hospital, Marxzeller Str. 46, 75305, Neuenbürg, Germany
| | - Heiko Reichel
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sebastian Weckbach
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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Luz J, Zweifel D, Hüllner M, Bühler M, Rücker M, Stadlinger B. Oral manifestation of Langerhans cell histiocytosis: a case report. BMC Oral Health 2018; 18:106. [PMID: 29884166 PMCID: PMC5994067 DOI: 10.1186/s12903-018-0568-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/11/2017] [Accepted: 05/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background Bone necrosis of the jaw is a serious condition with a broad differential diagnosis of pathologies such as cutaneous histiocytosis, bone metastases or malignant tumours. In addition to the most common cause, medication related osteonecrosis of the jaw (MRONJ), one must consider a number of other causes, such as histiocytosis. Langerhans cell histiocytosis (LCH) is a histiocytic disorder with a large spectrum of clinical manifestations and with possible involvement of a variety of organs. This case shows the importance of an early detection of this rare disease in order to prevent further spreading. Even if an initial diagnosis in the oral cavity is rare, dentists should be aware of this disease. Case presentation The presented case describes a patient who was referred for evaluation and treatment due to exposed bone and extensive osteolysis in the region of the upper and lower jaw. After biopsy and diagnosis of LCH, the patient was treated with systemic therapy, achieved remission and is disease free after a 2 year of follow up. Conclusions This case report illustrates that when dealing with unclear osteolytic changes of the jawbone, Langerhans cell histiocytosis must be taken into consideration in the differential diagnosis and biopsy must be performed in case of suspicion.
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Affiliation(s)
- Julia Luz
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
| | - Daniel Zweifel
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bühler
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
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Albert-Fort M, González-Candial M. A case report of orbital Langerhans cell histiocytosis presenting as a orbital cellulitis. ACTA ACUST UNITED AC 2018; 93:503-506. [PMID: 29643005 DOI: 10.1016/j.oftal.2018.03.003] [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: 11/27/2017] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 12/01/2022]
Abstract
CLINICAL CASE A 10-year-old girl was seen with a 3-week history of right upper lid swelling and with no other symptoms or fever. There was no recent history of sinusitis, trauma, or previous infection involving the periorbital area, or response to oral antibiotic treatment. Orbital computed tomography showed a lesion involving the upper margin of the orbit, and bone destruction at the orbital roof. Biopsy performed revealed the presence of Langerhans cell Histiocytosis. The lesion was surgically debulked and corticosteroids were used intra-operatively. The lesion responded to treatment. DISCUSSION The orbital involvement of Langerhans cell histiocytosis, despite its low incidence, should be considered in the examination of acute peri-orbital swelling. It usually presents as an osteolytic lesion, and it is confirmed with a histological examination and immunohistochemical techniques for CD1a and S100. An interdisciplinary approach is recommended to rule out multifocal or multisystemic diseases, as well as to develop an appropriate treatment strategy.
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Affiliation(s)
- M Albert-Fort
- Unidad de Órbita y Oculoplástica, Servicio de Oftalmología, Hospital Universitario de Gerona Dr. Josep Trueta, Gerona, España.
| | - M González-Candial
- Unidad de Órbita y Oculoplástica, Servicio de Oftalmología, Hospital Universitario de Gerona Dr. Josep Trueta, Gerona, España
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Marchioni D, Musumeci A, Fabbris C, De Rossi S, Soloperto D. Endoscopic transnasal surgery of clival lesions: our experience. Eur Arch Otorhinolaryngol 2018; 275:1149-56. [PMID: 29520496 DOI: 10.1007/s00405-018-4928-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors' Skull Base Team. PATIENTS AND METHODS This was a retrospective chart review of patients who underwent an endoscopic exclusive transnasal approach (EEA) or a transoral one (TO) for clival lesions between June 2015 and November 2017 at our Skull Base Referral Center. Patient characteristics and symptoms, preoperative neuroradiological evaluation, surgical approach, complications, and postoperative results were evaluated. RESULTS Nine patients (6 females and 3 males; age range 6-82 years, mean 50.8 years) underwent EEA or TO. From histological analysis, we found chordomas (6/9 subjects), chondrosarcoma (1/9), craniopharyngioma (1/9), and eosinophilic granuloma (1/9). Three patients had previously been operated for a parasellar chondrosarcoma (1/9), a pituitary macroadenoma (1/9), or a chondroid chordoma (1/9). The lesions were totally (2/9) or sub-totally (5/9) resected, debulked (1/9), or analyzed with a biopsy (1/9). Reconstruction was accomplished with a multilayer technique (7/9), or with a gasket-seal (1/9), using a mucoperichondrial graft, a single/double nasoseptal flap, a middle turbinate flap, a fascia lata, or a synthetic fascia. One patient (11.1%) was re-operated on due to cerebrospinal leakage, without further complications. Two patients (22.2%) were re-operated on due to chordoma regrowth. Adjuvant chemotherapy was administered to 1/9 patient with progressive healing. All of the other patients underwent proton-beam radiotherapy with no documented tumor growth (median follow-up: 20 months; range 5.1-29.9 months). CONCLUSIONS Clival lesions represent a heterogeneous group of lesions located in a very complex and difficult area. EEA and TO approaches are safe and mini-invasive, with lower morbidity and with postoperative complications when compared to the traditional open approaches, according to the extent and type of pathology.
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Abstract
Background Eosinophilic granuloma (EG), one of the three clinical forms of Langerhans cell histiocytosis (LCH), is a benign inflammatory reaction to an unknown etiologic agent. It most commonly occurs in children and young adults. The most frequently involved bones are the skull, the ribs and the femurs. Alongside the cranium, the maxilla and mandible can also be affected. Case Details Herein, we report a case of eosinophilic granuloma in a ten years old boy involving posterior quadrants upper and lower jaws as a destructive lesion involving gingiva, periodontium and alveolar bone. Involvement of other bones is ruled out by nucleotide imaging study. Conclusion EG should be considered as a differential diagnosis whenever there is a bony destructive lesion involving alveolar bone of the Jaws. Early diagnosis and surgical intervention will resolve the lesion.
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Affiliation(s)
- Karthiga Kannan
- Department of Oral Medicine & Radiology, College of Dentistry, Majmaah University, Saudi Arabia
| | - Naif Alwithanani
- Department of Periodontics, College of Dentistry, Majmaah University, Saudi Arabia
| | - Mohamed Salama
- Department of Periodontics, College of Dentistry, Majmaah University, Saudi Arabia
| | - Manoj Kumar
- Department of Oral Medicine & Radiology, Hail University, Saudi Arabia
| | - Roshan Uthappa
- Department of Endodontics, Majmaah University, Saudi Arabia
| | - Mazood Ahamed
- Department of Periodontics, College of Dentistry, Majmaah University, Saudi Arabia
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Rai S, Sridevi HB, Pai RR, Sanyal P. A Case of Multifocal Eosinophilic Granuloma Involving Spine and Pelvis in a Young Adult: A Radiopathological Correlation. Indian J Med Paediatr Oncol 2018; 38:555-558. [PMID: 29333031 PMCID: PMC5759083 DOI: 10.4103/ijmpo.ijmpo_130_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/30/2022] Open
Abstract
We present a case of multiple osteolytic lesions in a 28-year-old adult who presented with headache, back pain, and hip pain of 6 months. There was no history of localized swelling or rise of temperature, no history of weight loss or evening rise of temperature. On examination, there were no focal neurological deficits. Routine laboratory investigations, including total leukocyte counts, differential leukocyte counts, hemoglobin, and platelet counts, were within normal limits. There was a borderline elevation of erythrocyte sedimentation rate. Non enhanced computer tomography (NECT) demonstrated no abnormality in the brain or skull bones. However, incidentally, a lytic lesion involving the third cervical (C3) vertebral body and the neural arch was detected which also demonstrated a soft tissue component adjacent to the lytic lesion. These findings warranted further work up; and magnetic resonance imaging of whole spine and pelvis was performed that revealed multiple bony lesions involving the cervical vertebrae, head and neck, bilateral femur, sacrum, and iliac bones. Computed tomography-guided biopsy was performed from the C3 vertebral lytic lesion which showed features of eosinophilic granuloma on histopathological evaluation.
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Affiliation(s)
- Santosh Rai
- Department of Radiodiagnosis, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India
| | - H B Sridevi
- Department of Pathology, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India
| | - Radha R Pai
- Department of Pathology, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India
| | - Pulastya Sanyal
- Department of Radiodiagnosis, Kasturba Medical College (Manipal University), Mangalore, Karnataka, India
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Abstract
PURPOSE To describe the clinical presentation, treatment, and outcome of patients with histiocytic lesions of the orbit. METHODS Retrospective study of 9 patients treated and followed up between October 2001 and January 2018. RESULTS Eight patients in our series were males and one patient was female. The mean age at presentation was 16.8 years (range, 1 to 42 years). All patients had unilateral disease. The most common presenting complaint was upper eyelid swelling in 8 of 9. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Eight of 9 patients demonstrated orbital bone erosion with adjacent soft tissue mass. Destruction of the orbital roof and contrast enhancement of dura were detected in 3 cases. All cases underwent orbitotomy and subtotal tumor excision with additional bone curettage (4 cases) and intraorbital steroid (40 mg triamcinolone acetonide) injection (3 cases). Adjuvant systemic chemotherapy consisting of vinblastine and prednisone was administered in 3 cases with dural involvement. External radiotherapy (1000 cGy) was applied in one case because of widespread disease. Histopathologic diagnoses were eosinophilic granuloma (7 cases), necrotic xanthogranuloma (1 case), and Langerhans cell sarcoma (1 case). The mean follow-up period after diagnosis was 19.7 months (range, 1-96 months). There was no systemic or multifocal bone involvement in eosinophilic granuloma cases at initial presentation and follow-up. None of these patients developed diabetes insipidus or neurologic symptoms. The patient with Langerhans cell sarcoma died from systemic disease 1 month after diagnosis of the orbital tumor. The patient with necrotic xanthogranuloma did not develop any malignancy at 9 months follow-up. CONCLUSIONS Eosinophilic granuloma was the most frequently encountered orbital histiocytic lesion in our series. Eosiophilic granuloma usually responded well to subtotal tumor excision, bone curettage, and intraorbital corticosteroid injections. Systemic chemotherapy was used in cases with full thickness bone destruction and adjacent dural enhancement in an effort to prevent the development of central nervous system disease.
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Affiliation(s)
- A. Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Abstract
Eosinophilic ulcer (EU) is a rare self-limiting chronic benign ulcerative lesion of the oral mucosa often misdiagnosed as oral malignancy. Its etiopathogenesis is ambiguous, but trauma plays an important role in the development. Microscopically, it is characterized by a polymorphic inflammatory infiltrate with a prominent eosinophilic component and large mononuclear cells extending deep into the submucosa, underlying muscle and salivary glands. We discuss a case of EU in a 55-year-old male, which presented with a symptomatic nonhealing ulcer on the right lateral border of the tongue and was further clinically misdiagnosed as malignant ulcer.
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Affiliation(s)
- Kunal Sah
- Department of Oral Pathology and Microbiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Sunira Chandra
- Department of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Anil Singh
- Department of Oral Pathology and Microbiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Shweta Singh
- Department of Oral Pathology and Microbiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
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Tfifha M, Gaha M, Mama N, Yacoubi MT, Abroug S, Jemni H. Atlanto-axial langerhans cell histiocytosis in a child presented as torticollis. World J Clin Cases 2017; 5:344-348. [PMID: 28868307 PMCID: PMC5561504 DOI: 10.12998/wjcc.v5.i8.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/21/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare condition mostly seen in children and adolescents. Eosinophilic granuloma (EG) is one of its three clinical entities and is considered as a benign osteolytic lesion. Many reports of patients with spine histiocytosis are well documented in the literature but it is not the case of atlantoaxial localization. We report here a new observation of atlantoaxial LCH in a 4-year-old boy revealed by persistent torticollis. He was successfully treated with systemic chemotherapy and surgery. Inter-body fusion packed by autologous iliac bone was performed with resolution of his symptoms. It is known that conservative treatment is usually sufficient and surgery should be reserved for major neurologic defects in spine EG. In atlantoaxial lesion, surgical treatment should be frequently considered.
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Majumder A, Wick CC, Collins R, Booth TN, Isaacson B, Kutz JW. Pediatric Langerhans cell histiocytosis of the lateral skull base. Int J Pediatr Otorhinolaryngol 2017; 99:135-140. [PMID: 28688556 DOI: 10.1016/j.ijporl.2017.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/02/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Describe the presentation, imaging characteristics, management, and outcomes of pediatric patients with Langerhans cell histiocytosis (LCH) of the temporal bone. METHODS A retrospective chart review was performed between 2000 and 2014 at a single tertiary care children's hospital. Fourteen patients were identified with a diagnosis of LCH and involvement of the temporal bone. RESULTS Ten patients were female and ten were Caucasian. Mean age at diagnosis was 3 years (range 0.3-9.6 years). The most common presenting symptoms were scalp lesions, postauricular lesions, otalgia, and persistent ear infections. Three patients had documented hearing loss. Four cases had otic capsule invasion. Computed tomography demonstrated a lytic temporal bone lesion within the following subsites: mastoid, squamous temporal bone, external auditory canal, middle ear, and petrous apex. Four patients had intracranial disease. Extent and location of disease prompted all patients to be initially managed with chemotherapy. Surgical excision was limited to one case of localized recurrence. After a mean follow-up of 85.2 months (SD 42.4 months) there were no deaths but eight patients had a recurrence. Two patients developed long-term otologic sequelae requiring surgery. One patient developed labyrinthitis ossificans. CONCLUSION LCH has a varied presentation, age distribution, and treatment algorithm. This series of 14 pediatric patients with temporal bone involvement supports a limited role for surgical resection. Long-term follow-up is critical for detection of local and disseminated disease, and for monitoring of otologic complications.
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Affiliation(s)
- Ananya Majumder
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cameron C Wick
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca Collins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy N Booth
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandon Isaacson
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Walter Kutz
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Safarian A, Derakhshan N, Taghipour M, Dehghanian A. Eosinophilic granuloma at the cerebellopontine angle in an adult; a rare case report and literature review. Int J Surg Case Rep 2017; 37:183-5. [PMID: 28700967 DOI: 10.1016/j.ijscr.2017.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) is a rare immunologic disorder, identified by immature proliferation of histiocytes which may present as systemic or focal lesions. Eosinophilic granuloma (EG) is localized from of LCH mainly involving bones such as skull, femur, spine, ribs, mandible and pelvis. Cerebello-pontine (CP) angle is a rare anatomic location for involvement by EG. PRESENTATION OF CASE A 32 year old man was being evaluated in our neuro-oncology clinic due to diplopia since 4 months ago. On physical examination he had left sided abducens paresis, hyposthesia over left half of his face and a decreased corneal reflex on left side. A magnetic resonance imaging (MRI) study revealed a lesion at left CP angle measuring 30×25×25mm in size which was isointense in T1, hypointense on T2 with homogenous enhancement in post-contrast study. A standard retrosigmoid approach was carried out for resection of this lesion. Pathology report of the frozen section depicted infiltration of eosinophils and large mono-nuclear cells. The infiltrative nature of the lesion encouraged us not to attempt further resection. Permanent pathology report was in favor of EG. Patient was referred to an oncology clinic for proceeding with the steroid therapy. DISCUSSION To the best of authors' knowledge, this is the first report of EG at CP angle in an adult, in the literature. Infiltration of eosinophils and positivity for CD1a and S-100 renders the diagnosis unmistakable. CONCLUSION When the diagnosis is suggestive of EG, incompletely excised lesions can be further managed by steroid therapy.
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Kuroda K, Kashiwagi S, Teraoka H, Kinoshita H, Nanbara M, Noda E, Chikugo T, Hirakawa K, Ohira M. Kimura's disease affecting the axillary lymph nodes: a case report. BMC Surg 2017; 17:63. [PMID: 28549475 PMCID: PMC5446720 DOI: 10.1186/s12893-017-0260-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 01/16/2017] [Accepted: 05/21/2017] [Indexed: 12/27/2022] Open
Abstract
Background Kimura’s disease (KD; eosinophilic granuloma of soft tissue) is an inflammatory granulomatous disorder of unknown cause with eosinophilic infiltration that occurs mainly in soft tissue. KD occurs mainly in the head and neck, but development in the axillary region is very rare. Case presentation A 74-year-old Japanese woman was evaluated for a mass that she noted in the left axillary region. On physical examination, there was a palpable, thumb-sized, hard, elastic, freely movable mass in the left axilla. Blood tests showed elevated soluble interleukin-2 receptor (sIL-2R), normal serum immunoglobulin (Ig) G4, and elevated serum IgE. Ultrasonography of the left axilla showed multiple lymph nodes (LNs) with irregular margins in which central hyperechogenicity was lost. A systemic search by computed tomography (CT) showed no systemic lymphadenopathy or other mass-like lesions suspicious for a primary tumour other than in the left axillary LNs. Biopsy of an excised LN was performed under local anaesthesia for a definitive diagnosis. Histopathology showed various-sized lymphoid follicles, large nodular lesions with an enlarged mantle zone, multiple various-sized germinal centres in single nodules, and eosinophilic infiltration between the nodes. Immunohistochemical (IHC) staining of the germinal centres was positive for cluster of differentiation (CD) 10, positive for B-cell lymphoma (bcl)-6, and negative for bcl-2. These findings led to a diagnosis of KD. Ultrasound after 3 months of follow-up showed disappearance of the axillary lymphadenopathy. Conclusions A very rare case of KD in the axillary LNs was described. KD has the potential to occur in any region.
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Affiliation(s)
- Kenji Kuroda
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan.,Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
| | - Hitoshi Teraoka
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Haruhito Kinoshita
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Mikio Nanbara
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Eiji Noda
- Department of Surgery, Baba Memorial Hospital, Higashi 4-244 Hamadera Funao-cho, Nishi-ku, Sakai, Osaka, 592-8555, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, 589-8511, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Zhou Z, Zhang H, Guo C, Yu H, Wang L, Guo Q. Management of eosinophilic granuloma in pediatric patients: surgical intervention and surgery combined with postoperative radiotherapy and/or chemotherapy. Childs Nerv Syst 2017; 33:583-93. [PMID: 28247113 DOI: 10.1007/s00381-017-3363-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Eosinophilic granuloma (EG) of spine in pediatric patients presents kinds of clinical manifestation and a difficult management scenario. The choice of treatment, issues of surgical intervention versus conservative treatment, combination therapy or single treatment, all these factors, including neurological deficits, spinal stability, long-term complications, and continued skeletal growth, must be considered. METHODS From 2008 to the 2015, 31 pediatric patients of spinal EG were retrospectively reviewed. They were 17 males and 14 females, with a mean age 8.89 ± 2.84 years old (range, 3.5-14 years old). All the cases were divided into two groups. Twenty-three cases (Group S) accepted surgical interventions and surgery combined with local low-dose radiotherapy and/or chemotherapy. Eight patients (Group C) accepted radiotherapy and/or chemotherapy. All the patients had imaging studies of the lesion including standard radiography, three-dimensional computed tomography (CT) scan, and magnetic resonance imaging (MRI) prior to and after treatment. Cases in group S underwent surgery-related treatment, which include six patients accepted surgery only, nine patients accepted postoperative low-dose radiotherapy, four patients accepted additional chemotherapy, and four patients accepted both. Cases in group C accepted radiotherapy and/or chemotherapy, which include five patients accepted radiotherapy, one patient accepted chemotherapy, and two patients accepted both radiotherapy and chemotherapy. Clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and/or complications were recorded and analyzed. RESULTS All the 31 patients had pain relief (both in group S and group C) but the patients in group S obtained more prompt pain relief. All the patients in group S obtained local kyphosis correction, reconstruction of stability of spine, and recovery of neurological deficit after treatment. They have no surgery-related complications after treatment and in follow-up. Seventeen patients who received additional postoperative radiotherapy and/or chemotherapy also had good outcomes. There were no severe radiation and chemotherapy complications in procedure. The patients (group C) who accepted non-surgical treatment also have no severe complications, and a new femur lesion was found in one patient in follow-up. CONCLUSION Surgical intervention, including anterior and/or posterior approach with bone graft or surgery combined with postoperative low-dose radiotherapy and/or chemotherapy is a safe and effective way for treatment of the spinal EG. Compared with radiotherapy and/or chemotherapy, more prompt pain relief can be achieved via surgical intervention or surgery combined radiotherapy and/or chemotherapy.
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Di Felice F, Zaina F, Donzelli S, Negrini S. Spontaneous and complete regeneration of a vertebra plana after surgical curettage of an eosinophilic granuloma. Eur Spine J 2017; 26:225-228. [PMID: 28361364 DOI: 10.1007/s00586-017-5063-1] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE The eosinophilic granuloma is a unifocal or multifocal Langerhans cell histiocytosis characterized by an expanding proliferation of Langerhans cells in bones. Skeletal LCH is a rare condition, and vertebral regeneration in cases of vertebral body collapse is even rarer. We report the case of a girl with spontaneous complete healing. METHODS AD RESULTS A 3-year-old girl was referred for nighttime back pain, with no fever and no neurologic signs. Within a few days, she developed sudden painful restriction of all spine movements. X-ray and computed tomography (CT) of the spine showed reduced T7 vertebral body height (vertebra plana).The patient underwent T7 curettage and the histopathological exam was suggestive of LCH. Two additional skull lesions were found and therefore she underwent chemotherapy. After 7 years of follow-up, total vertebral reconstruction was observed. CONCLUSIONS Despite the rarity of the condition and despite the rarity of vertebral body lesion resolution, total vertebral body reconstruction was observed over a 7-year period. Long-term follow-up is necessary for a better understanding of the final outcome of patients with EG.
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Affiliation(s)
- Francesca Di Felice
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy.
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy
| | - Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,IRCCS Fondazione Don Gnocchi, Milan, Italy
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Abstract
Langerhans cell histiocytosis (LCH), previously known as histiocytosis X, is an uncommon hematological disorder affecting infants and young children. It is the condition characterized by uncontrolled stimulation and proliferation of normal antigen presenting cells, Langerhans cells. Because of its relatively low incidence, limited data are available regarding the epidemiology of LCH, with estimation of 2–5 cases per million inhabitants per year. The purpose of this report is to describe the case of LCH in the 3-year-old male child with multiple focal involvements of bones and to discuss clinical, radiological and histopathological features of LCH and role of the dental surgeon in diagnosing and managing such lesions.
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Affiliation(s)
- Dhanu G Rao
- Department of Pedodontics and Preventive Dentistry, AME Dental College and Hospital, Raichur, Karnataka, India
| | - Malay Vishnuprasad Trivedi
- Department of Pedodontics and Preventive Dentistry, AME Dental College and Hospital, Raichur, Karnataka, India
| | - Raghavendra Havale
- Department of Pedodontics and Preventive Dentistry, AME Dental College and Hospital, Raichur, Karnataka, India
| | - S P Shrutha
- Department of Pedodontics and Preventive Dentistry, AME Dental College and Hospital, Raichur, Karnataka, India
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Zhong N, Xu W, Meng T, Yang X, Yan W, Xiao J. The surgical strategy for eosinophilic granuloma of the pediatric cervical spine complicated with neurologic deficit and/or spinal instability. World J Surg Oncol 2016; 14:301. [PMID: 27923375 PMCID: PMC5141639 DOI: 10.1186/s12957-016-1063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/14/2016] [Accepted: 11/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Various therapeutic approaches have been proposed for the treatment of pediatric patients with eosinophilic granuloma (EG) of the cervical spine. Our aim was to discuss and present our experience with the individualized surgical intervention of pediatric cervical EG complicated with neurologic deficits and/or spinal instability. Methods We retrospectively analyzed the clinical data of 19 children who were diagnosed with cervical EG comor spinal/or spinal instability (evaluated by the Spinal Instability Neoplastic Score, SINS ≥ 7) and treated surgically in our institution. Results Lesions involved C1–2 in 7 patients and C3–7 in 12 patients. Anterior tumor resection combined with posterior pedicle screw fixation, anterior approach of excision and instrumentation, and posterior tumor resection combined with pedicle screws instrumentation were selected according to the different locations of tumors. Frankel scale and Oucher scale improved significantly after surgery. There was no morphologic alteration of the neck at follow-up. Conclusions Surgery can significantly improve the neurologic status and symptoms. Surgical decision-making must be individually tailored to minimize the influence of surgery on spine growth.
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Affiliation(s)
- Nanzhe Zhong
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Tong Meng
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wangjun Yan
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Angelini A, Mavrogenis AF, Rimondi E, Rossi G, Ruggieri P. Current concepts for the diagnosis and management of eosinophilic granuloma of bone. J Orthop Traumatol 2016; 18:83-90. [PMID: 27770337 PMCID: PMC5429252 DOI: 10.1007/s10195-016-0434-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
This review summarizes current concepts in the diagnosis and management of the patients with eosinophilic granuloma. Given the benign biology, the clinical course, and the pediatric group of patients that this condition more commonly affects, a treatment approach that carries a lower risk of complications while ensuring a successful cure is desirable. Variable treatment options have been reported with satisfactory results and a recurrence rate of less than 20 %. In this setting, symptomatic lesions that are accessible in the spine or the extremities may be treated with intralesional methylprednisolone injection after tissue biopsy for histological diagnosis.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, Athens, Greece
| | - Eugenio Rimondi
- Department of Radiology and Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Rossi
- Department of Radiology and Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Öğrenci A, Batçık OE, Ekşi MŞ, Koban O. Pandora's box: eosinophilic granuloma at the cerebellopontine angle-should we open it? Childs Nerv Syst 2016; 32:1513-6. [PMID: 26661575 DOI: 10.1007/s00381-015-2982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a disorder of immature LCH cells, eosinophils, macrophages, lymphocytes, and multinucleated giant cells. Eosinophilic granuloma (EG) is a focal form of LCH that presents mostly in the skull, femur, vertebrae, pelvis, mandible, and ribs. Intracranial presentation of EG is very rare in the literature. CASE DESCRIPTION A 17-year-old boy visited our clinic with headache, dizziness, and tinnitus that were present for 2 months. Brain MRI depicted a lesion at the right cerebellopontine angle. The lesion was hypointense on T1-weighted and hyperintense on T2-weighted brain MR images. The lesion enhanced homogenously after I.V. contrast material administration. Pre-operative diagnoses were vestibular schwannoma and meningioma. Surgery was planned. Retrosigmoid approach was preferred in the surgery. The lesion was excised partially. Pathological analysis depicted cell infiltration composed of eosinophils besides histiocytes, plasma cells, and lymphocytes in different amounts. CD1a was positive yet S100 was negative. Final diagnosis was eosinophilic granuloma. Post-operative course was uneventful. The patient was referred to pediatric oncology unit, and steroid therapy was initiated. Post-operative follow-up brain MRIs showed that the lesion had regressed further than immediate post-operative images by only steroid use. In long-term follow-up, new lesions appeared on the patient's skin in multiple locations and in the sclera of his left eye. At the last follow-up (3 years post-operatively) skin and scleral lesions were noticed to have regressed spontaneously and the intracranial structures were tumor free. DISCUSSION AND CONCLUSION To the best of our knowledge, EG at the cerebellopontine angle has not been presented in the literature. What makes our case further unique is its negativity for S-100 antigen. Eosinophilic granuloma should be kept in differential diagnosis of mass lesions presented at the cerebellopontine angle, especially in children and young adults with high eosinophils and lymphocytes in their peripheral blood. Sole steroid trials could be conveyed in suspicious cases before any further intervention. If the lesions do not regress or enlarge with time, surgery should be considered. However, long-term follow-up of these patients is necessary since natural history of the disease has not been defined, yet.
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Affiliation(s)
- Ahmet Öğrenci
- Department of Neurosurgery, Batman State Hospital, Batman, Turkey
| | | | - Murat Şakir Ekşi
- Department of Orthopedic Surgery, University of California at San Francisco (UCSF), 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA.
| | - Orkun Koban
- Department of Neurosurgery, Göztepe Medical Park, Istanbul, Turkey
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Bakhaidar MG, Alghamdi FA, Baeesa SS. Spontaneous extradural hemorrhage due to Langerhans cell histiocytosis of the skull in a child: A rare presentation. J Pediatr Neurosci 2016; 11:52-5. [PMID: 27195034 PMCID: PMC4862289 DOI: 10.4103/1817-1745.181248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022] Open
Abstract
Eosinophilic granuloma (EG) represents a local form of Langerhans cell histiocytosis that occurs mostly in children. It usually presents with a gradually enlarging painless skull mass, and rarely presents a rapid clinical deterioration. This 7-year-old boy who was diagnosed with EG, based on a magnetic resonance imaging scan, after presenting with a painless right parietal swelling of 7-week duration. Three weeks prior his scheduled surgery, he presented to the emergency department with a 2-day history of sudden increased of the subcutaneous swelling associated with a headache, vomiting, and decreased the level of consciousness; there was no history of trauma. Brain computed tomography revealed a right parietal bone defect with large subgaleal and extradural hematoma. He underwent emergent surgical excision of the skull lesion and evacuation of the hematoma. Histopathological examination confirmed the diagnosis of EG. We aim to raise the awareness of physicians of this rare spontaneous hemorrhagic complication of EG and review the literature.
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Affiliation(s)
- Mohamad G Bakhaidar
- Department of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad A Alghamdi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saleh S Baeesa
- Department of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Ilik MK, Tumturk A, Ulutabanca H, Kücük A, Koc RK. Short Segment Stabilization by Protecting the Alar Ligaments in a Case of Eosinophilic Granuloma Involving the C2 Spine. World Neurosurg 2016; 91:669.e15-9. [PMID: 27032524 DOI: 10.1016/j.wneu.2016.03.059] [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: 02/07/2016] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments. CASE DESCRIPTION A 6-year-old boy was admitted to our clinic for neck pain. Computed tomography and magnetic resonance imaging revealed a lytic bone lesion involving the C2 vertebral body and pedicle without odontoid tip. The tumor was resected using an anterior retropharyngeal approach and a wide marginal resection method. The odontoid tip and alar ligaments were protected, and the costal autografts were located between the C1-odontoid tip and the C3 body. The costal graft was stabilized in the C3 body with a miniplate. Then, C1-C3 posterior fixation with fusion was performed. The craniocervical junction was not considered unstable because the occipital bone was not involved in the fusion. Histologic examination confirmed the diagnosis of eosinophilic granuloma. Fusion was detected on a 1-year postoperative cervical computed tomography scan. CONCLUSIONS The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion.
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Affiliation(s)
| | - Abdülfettah Tumturk
- Department of Neurosurgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Halil Ulutabanca
- Department of Neurosurgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ahmet Kücük
- Department of Neurosurgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Rahmi Kemal Koc
- Department of Neurosurgery, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Bhat S, Nazir P, Bashir H, Reshi R, Sheikh S, Wani R. Clinicopathological pattern of cranial unifocal Langerhans cell histiocytosis: A study at medical college hospital. Indian J Med Paediatr Oncol 2016; 36:183-5. [PMID: 26855527 PMCID: PMC4743185 DOI: 10.4103/0971-5851.166744] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Eosinophilic granuloma (EG) of bone refers to a generally benign form of Langerhans cell histiocytosis localized to the bone. Patients may present with a solitary lesion (monostotic) or multiple sites of involvement (polyostotic). Materials and Methods: This study was done to evaluate the clinicopathological pattern of 6 cases of EGs of the skull diagnosed at a tertiary care hospital. All patients of EG were included with the help of medical records over a 5-year period that is, November 2009 to November 2014. They all had been preoperatively evaluated by skull X-ray and computed tomography. To rule out a multifocal disease scintigraphy was performed in all cases preoperatively. Surgical excision was performed, and EG was diagnosed on histopathology and immunohistochemistry. Results: There was a male predominance. Parietal bone was the most common affected bone. Total excision of the lesion was performed in all cases. No patient received postoperative radiotherapy. The follow-up period ranged from 6 months to 3 years. No tumor recurrence was noted. Conclusion: With an unknown etiology, nonspecific clinical and radiological findings with diagnosis possible only on histopathological examination, EG needs to be considered in the differential diagnosis as a skull mass, especially in children.
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Affiliation(s)
- Salma Bhat
- Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Parvez Nazir
- Department of Radiodiagnosis, Real Scan Imaging and Diagnostic Centre, Srinagar, Jammu and Kashmir, India
| | - Humaira Bashir
- Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Ruby Reshi
- Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Sheema Sheikh
- Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rohi Wani
- Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Bumpass DB, Park A, Hill KT, Huang J, Friedman MV, Zebala LP. Eosinophilic granuloma of the sacrum treated with radiation therapy: a case report. Spine J 2016; 16:e53-7. [PMID: 26386170 DOI: 10.1016/j.spinee.2015.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Eosinophilic granulomas (EGs) of the sacrum have been reported in fewer than 10 patients. Treatment algorithms for these tumors remain poorly defined; there are no reports of treating solitary sacral EG with radiation therapy (RT). PURPOSE This study aimed to describe the presentation, treatment, and outcome of sacral EG in an adult patient with intractable pain and radiculopathy, treated in a novel fashion with RT. STUDY DESIGN/SETTING The study design was a case report from a tertiary cancer referral center. METHODS Patient records, imaging, and pathology were reviewed. RESULTS A 35-year-old man received 20 Gy of radiation to his S1 EG lesion. He subsequently developed vertebra plana of S1 causing symptomatic L5-S1 stenosis, but 15 months after RT treatment was free of pain or tumor recurrence. CONCLUSION Radiation therapy is an effective treatment option for sacral EG causing severe axial pain and neural impingement.
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Affiliation(s)
- David B Bumpass
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
| | - Andrew Park
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Kirk T Hill
- Department of Pathology, Washington University, 660 S. Euclid Ave, Campus Box 8118, St. Louis, MO 63110, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University, 660 S. Euclid Ave, Campus Box 8224, St. Louis, MO 63110, USA
| | - Michael V Friedman
- Mallinckrodt Institute of Radiology, Washington University, 660 S. Euclid Ave, Campus Box 8131, St. Louis, MO 63110, USA
| | - Lukas P Zebala
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
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Regev GJ, Salame K, Keynan O, Lidar Z. Resection of benign vertebral tumors by minimally invasive techniques. Spine J 2015; 15:2396-403. [PMID: 26165474 DOI: 10.1016/j.spinee.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/10/2015] [Accepted: 07/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Benign tumors of the vertebrae are generally an uncommon cause for surgery. Complete removal of these tumors requires in most cases extensive surgical technique that consists of generous surgical exposure followed by laminectomy, facetectomy, and sometimes even an instrumented fusion. PURPOSE The aim was to describe our experience in performing resection of benign vertebral tumors, using a minimally invasive surgical (MIS) approach. STUDY DESIGN This was a retrospective review of case records. PATIENT SAMPLE Patients who underwent MIS, resection of benign vertebral tumors. OUTCOME MEASURES Complete neurologic examination and pain evaluation, as measured by the visual analog scale (VAS). Secondary outcomes included postoperative spinal instability assessment and surgical margins examinations. METHODS Patients were evaluated preoperatively and postoperatively at 1, 3, and 6 months intervals clinically and radiographically using plain radiographs and postoperative computed tomography (CT) scans. Final pathologic report, operative time, blood loss, complications, and hospital length of stay were also recorded. RESULTS Between 2009 and 2013, 14 patients underwent MIS, resection of benign vertebral tumors at our institution. Mean follow-up time was 4 years. There were eight men and six women with a mean age of 27 years (range 16-68 years). For tumors located in the posterior elements, a direct posterior approach was used. Tumors located at the pedicle of the vertebra were excised using a transpedicular approach, and tumors protruding into the foramen were excised using the transforaminal approach. The transcanal approach was used when decompression of the thecal sac or nerve root was required, and the retroperitoneal transpsoas approach was used for tumors located in the vertebral body. Complete removal of these tumors was achieved in all cases, and was verified by a follow-up CT scan. Pathology revealed osteoid osteoma in five patients, osteoblastoma in three patients. Eosinophilic granuloma, fibrous dysplasia, and fibroid adenoma were found in one case each. Average VAS pain score improved from 7.7 (7-9) to 2.8 (0-7) after surgery. CONCLUSIONS Minimally invasive techniques are a valuable choice for the treatment of benign osseous tumors of the spine. A larger, long-term study is in progress. In the meantime, we suggest surgeons experienced with both open and MIS surgery should consider these techniques.
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Affiliation(s)
- Gilad J Regev
- Spine Surgery Unit, Department of Neurosurgery and Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv, 64239, Israel.
| | - K Salame
- Spine Surgery Unit, Department of Neurosurgery and Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv, 64239, Israel
| | - O Keynan
- Spine Surgery Unit, Department of Neurosurgery and Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv, 64239, Israel
| | - Z Lidar
- Spine Surgery Unit, Department of Neurosurgery and Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, 6 Weitzman Street, Tel Aviv, 64239, Israel
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Lam S, Reddy GD, Mayer R, Lin Y, Jea A. Eosinophilic granuloma/Langerhans cell histiocytosis: Pediatric neurosurgery update. Surg Neurol Int 2015; 6:S435-9. [PMID: 26539317 PMCID: PMC4604648 DOI: 10.4103/2152-7806.166761] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 01/21/2023] Open
Affiliation(s)
- Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Gaddum D Reddy
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Rory Mayer
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Yimo Lin
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Andrew Jea
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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50
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Abstract
Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by proliferation of bone marrow derived Langerhans cells and mature eosinophils. Their clinical features simulate common oral findings such as gingival enlargement, oral ulcers, and mobility of teeth, along with nonspecific radiographic features; hence, diagnosing such lesions becomes difficult for the oral physicians. These lesions are commonly seen in childhood; however, we are reporting a case of LCH in 29-year-old adult male. A provisional diagnosis of giant cell granuloma was considered based on history and examination, although the lesion was histologically proven to be LCH and was confirmed with immunohistochemical staining of S100 protein and CD1a antigen. The purpose of this paper is to enhance the understanding of diverse, nonpathognomical oral presentation of LCH that is easily misdiagnosed and overlooked by dentist.
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Affiliation(s)
- Y Pavan Kumar
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Rushikonda, Visakhapatnam, Andhra Pradesh, India
| | - Jayshree Agrawal
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Rushikonda, Visakhapatnam, Andhra Pradesh, India
| | - J Mohanlakshmi
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Rushikonda, Visakhapatnam, Andhra Pradesh, India
| | - P Suresh Kumar
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Rushikonda, Visakhapatnam, Andhra Pradesh, India
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