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Marvisi C, Sinico RA, Salvarani C, Jayne D, Prisco D, Terrier B, Emmi G, Vaglio A. New perspectives in eosinophilic granulomatosis with polyangiitis (EGPA): report of the first meeting of the European EGPA Study Group. Intern Emerg Med 2019; 14:1193-1197. [PMID: 31388893 DOI: 10.1007/s11739-019-02166-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/07/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023]
Abstract
The European Eosinophilic Granulomatosis with Polyangiitis (EGPA) study group first gathered in Firenze in December 2018. The discussion was centred around the clinical and therapeutic needs in EGPA which still remain unmet. Indeed, EGPA is a puzzling and rare disease which shares clinical features with other anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) and hypereosinophilic syndromes (HESs). Some of the recommendations published in 2015 are based on data derived from EGPA-related diseases, rather than from EGPA itself, and therefore need to be updated. Thus, the aim of the meeting was to stimulate ongoing research, to promote collaborative European studies and to define the main issues on which future studies should be focused. Current fields of research on EGPA include potential serological biomarkers of disease activity and of specific organ involvement, possible links between different genetic variants and clinical phenotypes, and new therapeutic perspectives. Herein, we give an overview of the meeting with the goal to stimulate an international collaboration and new points of discussion.
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Affiliation(s)
- Chiara Marvisi
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Renato Alberto Sinico
- Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Monza, Italy
| | - Carlo Salvarani
- University of Modena and Reggio Emilia, and Azienda USL-IRCCS, Reggio Emilia, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Dipartimento Di Medicina Sperimentale e Clinica, Università Di Firenze, Largo Brambilla 3, 50134, Florence, Italy
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Giacomo Emmi
- Dipartimento Di Medicina Sperimentale e Clinica, Università Di Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Augusto Vaglio
- SOC Nefrologia E Dialisi, Azienda Ospedaliero-Universitaria Meyer, e Dipartimento Di Scienze Biomediche, Sperimentali e Cliniche "Mario Serio", Università Di Firenze, Viale Pieraccini 6, 50139, Florence, Italy.
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Abstract
AIMS AND BACKGROUND Histiocytosis X is a condition characterized by an abnormal proliferation of histiocytes with a variable granulomatous and inflammatory component; bone involvement is almost always present. The aim of this study was to define the management of solitary eosinophilic granuloma (EG) of the calvaria in adult patients, in relation to the size and site of the lesion. METHODS Fourteen patients, ranging in age from 7 to 45 years, with solitary eosinophilic granuloma of the calvaria were surgically treated by craniectomy or curettage and cranioplasty. We subgrouped the lesions into two types: A) lesions localized inside the diploë and/or compressing the cerebral parenchyma below but without dural infiltration; B) lesions with mainly intracranial growth, compressing the cerebral parenchyma and infiltrating the dura. The infiltrated dura mater in type B lesions was replaced with a dural patch. Cranioplasty was performed in lesions with a diameter of 4 cm or more and/or located in aesthetically exposed areas of the skull. RESULTS None of the patients died during the study and no local or systemic recurrences were observed during follow-up (min. 3 yrs, max. 8 yrs). CONCLUSIONS Surgical treatment of patients with isolated EG of the calvaria not only is simple and quick but also allows histological diagnosis of the osteolytic lesion. These patients do not require further adjuvant treatment. Cranioplasty should be performed when the lesion has a diameter of 4 cm or more, when it is located in aesthetically exposed areas of the skull such as the frontal or temporal bones, or when it produces alterations of the normal skull morphology.
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Affiliation(s)
- F Puzzilli
- Department of Neurological Sciences, Second Chair of Neurosurgery, University of Rome La Sapienza, Italy
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Abstract
RATIONALE Solitary eosinophilic granuloma (EG), the most benign, common form of Langerhans cell histiocytosis, has a self-limiting process and is associated with a good prognosis. Immobilization is recommended as the first treatment strategy for solitary EG, although the treatment protocols are still controversial. Radiotherapy and surgery are secondary treatment choices. Lesions of the upper cervical spine react differently to treatment because of their specific anatomical and motor features. PATIENT CONCERNS We discuss the case of a 29-year-old man with axis EG who underwent immobilization, radiotherapy, and finally surgery. DIAGNOSIS Eosinophilic granuloma (EG). INTERVENTIONS An initial conservative protocol, including immobilization with a collar and radiotherapy, effectively relieved his neck pain, whereas torticollis secondary to atlantoaxial subluxation was not improved. Therefore, he underwent tumor resection through the anterior approach and spinal reconstruction, fixation, and fusion through the posterior approach. OUTCOMES The deformity was well corrected and follow-up was satisfactory. LESSONS Upon review of the literature, we found that EG lesions affecting the axis have more risk factors for instability or deformity, and they have particular anatomical and motor characteristics; thus, they require more consideration and attention in terms of treatment, prognosis, and follow-up.
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Affiliation(s)
- Yu Song
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Wen Geng
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| | - Tao Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yong Gao
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yukun Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Shuai Li
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Ji Tu
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei
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Li J, Chen FT, Xu JR. [Surgical treatment combined with oral administration of indomethacin for eosinophilic granuloma of the skull: report of a pediatric case]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2014; 43:501-503. [PMID: 25187468 DOI: 10.3785/j.issn.1008-9292.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 13-year-old girl presented headache for 5 d upon admission to hospital. An initial CT revealed 3 lesions located in her skull, the sizes of which were 2.5 cm×3.2 cm,1.2 cm×1.0 cm,0.3 cm×0.3 cm, respectively. The largest lesion was resected by surgery and confirmed as eosinophilic granuloma by pathology. After surgery, she took oral indomethacin 25 mg b·i·d for 3 months and tolerated it well. CT scan was performed 3 months and 1 year later, and the results showed that the unresected lesions shrank progressively and the defected bones were regenerated and healed one year later after operation.
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Affiliation(s)
- Jiang Li
- Department of Neurosurgery, Affiliated Hospital , College of Medicine, Ningbo University, Ningbo 315020, China
| | - Fu-ting Chen
- Department of Neurosurgery, Affiliated Hospital , College of Medicine, Ningbo University, Ningbo 315020, China
| | - Jiang-rong Xu
- Department of Neurosurgery, Affiliated Hospital , College of Medicine, Ningbo University, Ningbo 315020, China
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Sauerborn D, Pajić-Penavić I, Stojadinović T. Eosinophilic granuloma of the temporal bone in an adult: controversies in the management. Coll Antropol 2012; 36 Suppl 2:163-166. [PMID: 23397778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Eosinophilic granuloma is a rare, benign, lesion characterized by uncontrolled proliferation of Langerhan's cells. It is commonly found in a bone and has been described in almost every bone in the body. It usually affects children and is seldom found in adults. A case of 60-year-old adult male with an eosinophilic granuloma of the right temporal bone with infiltration of the temporal and infratemporal fossa and osteolysis of the squama of the temporal bone is presented. Diagnostic procedure and course of treatment are described. Controversies in the management and different approaches in therapy of such lesion are discussed because there is no agreed treatment protocol established.
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Affiliation(s)
- Damir Sauerborn
- Dr. Josip Bencević General Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Slavonski Brod, Croatia.
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Ioannidis O, Sekouli A, Paraskevas G, Chatzopoulos S, Kotronis A, Papadimitriou N, Konstantara A, Makrantonakis A, Kakoutis E. Long term follow up of eosinophilic granuloma of the rib. Klin Onkol 2011; 24:460-464. [PMID: 22257236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED BACKROUNDS: Eosinophilic granuloma is one of the rarest causes of bone tumors, especially in adults. Eosinophilic granuloma is the commonest form of Langerhans cell histiocytosis and represents the unifocal osseous form of the disease which usually affects the skull and long bones. Eosinophilic granuloma, is a benign disease in which diagnosis and differential diagnosis presents more difficulties than treatment. OBSERVATION We present a case of eosinophilic granuloma of the rib with long term follow-up of 14 years which was treated with a combination of surgery and chemotherapy. CONCLUSION Prognosis of adult eosinophilic granuloma is excellent and the recurrence rate is limited. All available treatment options, including surgery, chemotherapy, corticosteroids, radiation, and even palliative treatment have very good results and in many cases the disease seems to heal spontaneously. However the disease, due to its rarity and unknown pathogenesis still remains an enigma for the clinical doctor.
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Affiliation(s)
- O Ioannidis
- First Surgical Department, General Regional Hospital George Papanikolaou,Thessaloniki, Greece.
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Fiala KH, Wells MJ, Stetson CL, Cecalupo AJ. When a bump can be a hole. Arch Dermatol 2007; 143:1083-4. [PMID: 17709680 DOI: 10.1001/archderm.143.8.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Ramani P, Chandrasekar T, Baig MF, Muthusekar MR, Thomas S, Manyam R, Senthil MS. Langerhans cell histiocytosis of the mandible in a six-year-old child. Indian J Dermatol Venereol Leprol 2007; 73:114-6. [PMID: 17456920 DOI: 10.4103/0378-6323.31899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Histiocytosis is a term applied to a group of rare disorders of the reticuloendothelial system. Eosinophilic granuloma, the most benign and localized of the three Langerhans cell histiocytosis entities, may be solitary or multiple. Eosinophilic granuloma can affect almost any bone, but commonly involves the mandible when the jaws are affected. Conventional treatment of LCH is with surgery, radiotherapy, chemotherapy and steroid injections, alone or in combination. Spontaneous regression of localized disease has also been reported. We report a six and a half-year-old patient with Langerhans cell histiocytosis--solitary eosinophilic granuloma of the mandible that initially regressed but rapidly recurred even after radical treatment and had a fatal outcome.
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Affiliation(s)
- Pratibha Ramani
- Department of Oral and Maxillofacial Pathology, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India.
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Abstract
OBJECT Tumors originating in the vertebrae in children are difficult to treat. In this paper the authors sought to evaluate the decision-making process and outcome of surgical intervention in this population given the complex issues of spinal stability, continued skeletal growth, intraoperative blood loss, and long-term outcome. METHODS To select patients for this study, the authors retrospectively reviewed medical records and images at the University of Iowa Hospitals and Clinics between 1996 and 2005. Their inclusion criteria were age younger than 18 years at the time of diagnosis and histopathological findings confirming that the tumor originated from vertebral bone. Sixteen patients met these requirements. In addition, the authors conducted a comparison with 45 patients in whom similar diagnoses were made prior to 1996. Gross-total resection of all nonmetastatic primary bone tumors is desired, as exemplified in 11 patients in this series; biopsy sampling only was performed in two others. Gross-total resection was also not performed in three patients with eosinophilic granuloma (EG). These three patients underwent nonsurgical treatment, which is different from how patients with EG were treated in the earlier study. Nine histopathological diagnoses were included; with a mean follow-up period of 3.7 years, the survival rate is 94%. The tumor recurred in one patient with a giant cell tumor of the sacrum. The authors performed preoperative tumor embolization and found that it was a useful adjunct to resection. Provocative testing prior to embolization was part of the protocol to reduce ischemic complications. Motion-sparing surgical procedures were performed in which a few segments were fused, preserving axial mobility. CONCLUSIONS Overall, early intervention offers the best symptomatic relief, which can only be rendered if sufficient clinical suspicion provokes early diagnostic imaging.
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Affiliation(s)
- Albert J Fenoy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Abstract
BACKGROUND/AIMS Eosinophilic granuloma (EG) involving the vertebrae in the pediatric population presents a difficult management scenario. Issues of surgical versus nonsurgical intervention, spinal stability and continued skeletal growth must all be considered. METHODS A retrospective review of medical records and radiographs from 1964 to the present yielded 12 patients with age less than 18 at the time of diagnosis of primary spinal EG. RESULTS Eleven of these 12 patients presented with pain; 2 patients had neurological deficits. Nine patients were managed nonsurgically, including those undergoing tissue diagnosis by needle (2) or extraspinal (3) biopsy; 3 patients underwent gross total resections. Radiographic diagnosis alone was made in 4. With an average follow-up of 8.1 years, survival is 100%. CONCLUSIONS EG in the spine infrequently produces neurological deficits in the pediatric age group, although it may result in spinal instability. As such, nonsurgical management is the preferred strategy to effect symptomatic relief.
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Affiliation(s)
- Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Abstract
BACKGROUND Eosinophilic granuloma (EG) is the mildest and mainly localized form of the clinicopathologic spectrum of Langerhans' cell histiocytosis. It is a destructive osseous lesion characterized by a vast number of eosinophils and histiocytes. The etiology remains unknown. In this paper, a case of EG is presented that was initially diagnosed and treated as aggressive periodontitis (AP). METHODS Despite treatment procedures, the EG continued to expand very quickly, destroying the lingual cortical bone and the neighboring soft tissues and exhibiting periosteal reaction. Diagnosis of EG was established on the basis of histopathologic and immunohistochemical evaluation. Moreover, certain manifestations in the skeletal and respiratory system were observed. RESULTS Surgical curettage of the lesions was effective; however, corticosteroids and low-dose radiation were used as adjunctive therapy. CONCLUSION The rapid progress of eosinophilic granuloma, the diagnostic problems, and the consequences of late diagnosis and treatment are discussed.
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Affiliation(s)
- S S Silvestros
- Department of Prosthodontics, Dental School, University of Athens, Athens, Greece.
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Affiliation(s)
- Paul B Bloom
- Allergy and Dermatology Clinic for Animals, 31205 Five Mile Road, Livonia, MI 48158, USA.
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Affiliation(s)
- Tien-Yi Tzung
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Abstract
We present a case of Langerhans cell histiocytosis (LCH) diagnosed in the mastoid bone. The tumor recurred in the ureter and maxillary sinus mucosa two years later. The diagnosis of LCH was based on morphology and immunohistochemistry. Involvement of the ureter and the maxillary sinus in LCH is extremely rare. To the best of our knowledge, this is the first case of LCH affecting the mastoid bone in a 16-year-old boy and recurring later in the ureter and maxillary sinus mucosa.
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Affiliation(s)
- Ju Han Lee
- Department of Pathology, Korea University Guro Hospital, Guro Ku, Seoul 152-703, Republic of Korea
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Pessier AP, Munson L, Miller RE. Oral, nasal, and cutaneous eosinophilic granulomas in the black rhinoceros (Diceros bicornis): a lesion distinct from superficial necrolytic dermatitis. J Zoo Wildl Med 2004; 35:1-7. [PMID: 15193066 DOI: 10.1638/03-039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Oral, nasal, and cutaneous lesions resembling eosinophilic granulomas (EGs) were observed in eight captive black rhinoceroses (Diceros bicornis). Oral lesions were observed in all affected animals and occurred most often behind the prehensile lip. The typical clinical history of affected animals included oral bleeding or epistaxis from multilobulated, fungating, proliferative masses with areas of ulceration. Histologically, lesions were characterized by prominent infiltrates of eosinophils and rare foci of collagen degeneration on a background of marked submucosal or dermal neovascularization. Mucosal or epidermal hyperplasia was also present sometimes in association with distinctive epithelial degenerative changes consistent with superficial necrolytic dermatopathy of black rhinoceroses. Lesions of EG and superficial necrolytic dermatopathy were interpreted as being concurrently manifested in these cases. EG lesions spontaneously resolved over periods of 30 days-7 mo and were recurrent in three animals. Lesions were responsive to treatment with corticosteroids or to local cryotherapy with liquid nitrogen. Two animals treated with systemic corticosteroids died of disseminated fungal infections, emphasizing that corticosteroids should be used cautiously in black rhinoceroses.
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Affiliation(s)
- Allan P Pessier
- University of Illinois Zoological Pathology Program, Loyola University Medical Center, Room 0745, Building 101, 2160 South First Street, Maywood, Illinois 60153, USA
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Anoop P, Anjay MA, Rajendran VR, Vasu CK, Regi George AN. A dancer with an unusual cause of neck pain. Indian J Pediatr 2004; 71:948. [PMID: 15531851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
A girl presented with a dull ache in the neck and mild difficulty in neck movements. She had limited clinical signs and her initial work up failed to reveal the cause. With the help of imaging modalities and CT guided needle biopsy, she was diagnosed to have an eosinophilic granuloma of the fifth cervical vertebra. There were no neurological symptoms. She was successfully managed with immobilization of spine, local irradiation and systemic vinblastine. The literature is briefly reviewed for clinical features, diagnosis and management.
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Shao S, Zheng JW, Shao Y, Zhang SL, Tang YS, Xu B. [Eosinophilic granuloma of the jaw: an analysis of 21 cases]. Shanghai Kou Qiang Yi Xue 2004; 13:328-30. [PMID: 15349680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE To study the clinical features and treatment of eosinophilic granuloma of the jaw (EGJ) in 21 cases. METHODS 21 patients with EGJ treated from 1983 to 2002 were reviewed, including the sexes, ages, extent of lesions, clinical features and treatment methods. RESULTS The male to female rate was 13:8. 76% of the cases were among 2-10 years. The median age was 8 years, 18 lesions were in the mandible, 1 was in the maxilla and 2 involved the mandible and maxilla. CONCLUSIONS EGJ was rarely seen clinically, lack of specificity. Pathology can confirm the diagnosis. Surgery is still the major treatment modality. Combination of radiotherapy or chemotherapy maybe valuable. The prognosis of the patients was generally good.
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Affiliation(s)
- Shan Shao
- Third People's Hospital of Jinan City, Shandong Jinan 250101, Shandong Province, China
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Ugenti I, De Ceglie A, Ferrarese F, Rizzo C, Manta R, Fabiano G. [Gastric anisakidosis: personal experience]. Chir Ital 2004; 56:301-5. [PMID: 15152528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Anisakidosis is a parasitic disease of the human gastrointestinal tract caused by ingestion of marine nematode larvae such as anisakis simplex or, rarely, Pseudoterranova, present in raw or undercooked fish. Frequent sites of involvement by anisakis are the stomach, small intestine, rarely the colon, or the peritoneum, liver, pancreas, lung and tonsils, anisakidosis is a self-limiting disease; the symptoms arise 12-24 hours after ingesting raw fish and include nausea, diarrhoea, and severe abdominal pain, but also anaphylactic reactions. At the site of penetration, anisakis causes marked oedema, eosinophilic infiltration and granuloma formation. There are haematological abnormalities such as marked leukocytosis of the peripheral blood, eosinophilia, and positive PCR and serum antibodies to the larva's surface antigens. The diagnosis of anisakidosis can be made by endoscopy, radiology and US, but the disease is often diagnosed at surgical intervention. In the gastric form of anisakidosis, EGIDS has both a diagnostic role and a therapeutic one because it is possible to remove the worm using biopsy forceps. We report on one case of gastric anisakidosis, in a women, hospitalised for intense epigastric pain and vomiting after ingesting raw fish. She underwent gastroscopy. A worm was extracted from the gastric mucosa using biopsy forceps. This was followed by clinical improvement. The worm was identified by its macroscopic and microscopic characteristics as an anisakis larva. At laboratory examination, marked leukocytosis and eosinophilia of the patient's peripheral blood were observed 3-4 days after ingestion of anisakis.
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Affiliation(s)
- Ippazio Ugenti
- Sezione di Chirurgia Generale, Dipartimento di Scienze Chirurgiche Generali e Specialistiche-Università degli Studi di Bari
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Woo KI, Harris GJ. Eosinophilic Granuloma of the Orbit: Understanding the Paradox of Aggressive Destruction Responsive to Minimal Intervention. Ophthalmic Plast Reconstr Surg 2003; 19:429-39. [PMID: 14625488 DOI: 10.1097/01.iop.0000092800.86282.27] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the findings and outcomes in eosinophilic granuloma (unifocal Langerhans-cell histiocytosis [LCH]) of the orbit and to explain the paradox of aggressive bone destruction responsive to minimal intervention. METHODS Retrospective, consecutive, interventional case series of patients treated from 1985 to 2001. Minimum inclusion criteria were demonstration of CD1a positivity or Birbeck granules, treatment by a single surgeon, systemic evaluation by a pediatric oncologist, and follow-up of 12 months. A pathogenetic construct was assembled from general LCH concepts and the specific orbital findings. RESULTS Seven patients met study criteria. All were male, 2 to 16 years of age. All had eyelid or forehead swelling and osteolytic defects, with symptoms of 2 to 6 weeks' duration. All underwent incisional biopsy, with frozen-section examination suggestive of LCH in 6 of 7 cases. The 2 earliest patients received low-dose irradiation after simple biopsy. The 5 most recent patients had subtotal curettage at the time of biopsy; 4 of 5 received simultaneous intralesional corticosteroid injection. In all cases, systemic evaluation showed no other focus of LCH, reossification was timely, and no local recurrence or additional focus was noted in follow-up of 1 to 17 years. CONCLUSIONS Transient immune dysfunction may provoke the cytokine-mediated proliferation of pathologic Langerhans cells within the hematopoietic marrow of the anterolateral frontal bone. These cells cause osteolysis through elaboration of interleukin-1 and prostaglandin E2. Corticosteroids can inhibit the mediators. We recommend incisional biopsy, frozen-section provisional diagnosis, subtotal curettage, intralesional corticosteroid instillation, postoperative systemic evaluation, and long-term surveillance.
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Affiliation(s)
- Kyung In Woo
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Khilnani GC, Kumar A, Dutta Gupta S, Kumar S. Unusual clinical presentation of pulmonary eosinophilic granuloma. Indian J Chest Dis Allied Sci 2003; 45:191-4. [PMID: 12866636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- G C Khilnani
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Oliveira M, Steinbok P, Wu J, Heran N, Cochrane D. Spontaneous resolution of calvarial eosinophilic granuloma in children. Pediatr Neurosurg 2003; 38:247-52. [PMID: 12686768 DOI: 10.1159/000069828] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Accepted: 01/21/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The recommended treatment for solitary calvarial eosinophilic granuloma (EG) is surgical resection by curettage, craniectomy or craniotomy. The purpose of this study was to describe the spontaneous resolution of calvarial EG and discuss 'observation only' as an option in the management of this condition. METHODS A retrospective review was performed of children with calvarial EG seen at a tertiary care children's hospital. Of a total of 17 such patients, four were managed without any intervention and formed the basis of this report. RESULTS In all four patients treated by 'observation only', there was a tender calvarial mass which enlarged rapidly over a few days and then resolved slowly over many weeks. The diagnosis of EG was based on the findings of plain radiographs and/or computed tomography. All masses had resolved by 8 weeks, and the underlying cranial defect filled in spontaneously in all cases. There was no recurrence at follow-up, which ranged from 2 months to 7 years. CONCLUSIONS 'Observation only' should be considered as a viable option in the management of children with solitary calvarial masses that have the radiographic features of EG. Consideration should be given to delaying surgical intervention to allow time to see if spontaneous resolution occurs.
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Affiliation(s)
- Marcelo Oliveira
- Division of Pediatric Neurosurgery, British Columbia's Children's Hospital, Children and Women's Health Centre, Vancouver, BC, Canada
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Harris GJ, Woo KI. Eosinophilic granuloma of the orbit: a paradox of aggressive destruction responsive to minimal intervention. Trans Am Ophthalmol Soc 2003; 101:93-103; discussion 103-5. [PMID: 14971567 PMCID: PMC1358978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE To describe the findings and outcomes in eosinophilic granuloma (unifocal Langerhans cell histiocytosis [LCH]) of the orbit, and to explain the paradox of aggressive bone destruction responsive to minimal intervention. METHODS Retrospective, consecutive, interventional case series of patients treated from 1985 through 2001. Minimum inclusion criteria were demonstration of CD1a positivity or Birbeck granules, treatment by a single surgeon, systemic evaluation by a pediatric oncologist, and follow-up of 12 months. A pathogenetic construct was assembled from general LCH concepts and the specific orbital findings. RESULTS Seven patients met study criteria. All were male, 2 to 16 years of age. All had eyelid or forehead swelling and osteolytic defects, with symptoms of 2 to 6 weeks' duration. All underwent incisional biopsy, with frozen-section examination suggestive of LCH in 6 of 7 cases. The 2 earliest patients received low-dose irradiation after simple biopsy. The 5 most recent patients had subtotal curettage at the time of biopsy; 4 of 5 received simultaneous intralesional corticosteroid injection. In all cases, systemic evaluation showed no other focus of LCH, reossification was timely, and no local recurrence or additional focus was noted in follow-up of 1 to 17 years. CONCLUSIONS Transient immune dysfunction may provoke the cytokine-mediated proliferation of pathologic Langerhans cells within the hematopoietic marrow of the anterolateral frontal bone. These cells cause osteolysis through elaboration of interleukin-1 and prostaglandin E2. Corticosteroids can inhibit the mediators. We recommend incisional biopsy, frozen-section provisional diagnosis, subtotal curettage, intralesional corticosteroid instillation, postoperative systemic evaluation, and long-term follow-up.
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Affiliation(s)
- Gerald J Harris
- Section of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College Wisconsin, Milwaukee, USA
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Ghanem I, Tolo VT, D'Ambra P, Malogalowkin MH. Langerhans cell histiocytosis of bone in children and adolescents. J Pediatr Orthop 2003; 23:124-30. [PMID: 12499958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this paper was to analyze the orthopaedic aspects of Langerhans cell histiocytosis and to assess the outcome after treatment. Fifty-six patients with Langerhans cell histiocytosis involving the bone were retrospectively studied. Three groups were identified with regard to the type of bone involvement. Group I patients (n = 26) had a solitary bone lesion, with no systemic involvement. No treatment was given in 22 patients and curettage was done in 4 patients. At last follow-up, complete or partial healing was observed in 25 patients. Group II patients (n = 13) had multiple bone lesions, with no systemic involvement. Clinical and radiographic pictures as well as the outcome after treatment were similar to those in group I. Group III patients (n = 17) had bone and systemic involvement. Chemotherapy was used in all group III patients, with adjuvant radiotherapy in seven patients. Recurrence or new lesions were observed in 11 patients. Complications of treatment were observed in 14 patients. Lesions in group I and II patients had a considerable potential for spontaneous healing. Group III patients had the worst prognosis. Current chemotherapy protocols have a high morbidity and produce a variable response.
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Affiliation(s)
- Ismat Ghanem
- Children's Hospital Los Angeles, Los Angeles, California, USA.
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25
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Palumbo I, Palumbo B. Eosinophilic bone granuloma in an adult patient. Radiol Med 2002; 104:224-9. [PMID: 12471370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- I Palumbo
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Medicina Interna e Scienze Oncologiche, Università degli Studi di Perugia, Perugia, Italy.
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Abstract
STUDY DESIGN A meta-analysis was performed based on 53 cases of cervical eosinophilic granuloma reported in the literature and 1 in an adult treated by the authors. OBJECTIVE To stress the clinical and radiologic differences between cervical and thoracolumbar spinal eosinophilic granuloma and to point out differences between adults and children with cervical eosinophilic granuloma to avoid false diagnosis. SUMMARY OF BACKGROUND DATA Until now, cervical eosinophilic granuloma has been reported in 43 children and 9 adults. In 1 case the age is unknown. In previous studies, differences between adults and children with cervical eosinophilic granuloma have not been analyzed, nor has cervical eosinophilic granuloma been compared with thoracolumbar eosinophilic granuloma. METHODS All reported cases of cervical eosinophilic granuloma were analyzed concerning age and sex distribution, clinical and radiologic presentation, therapy, and outcome. The authors' case in a 46-year-old patient is discussed. RESULTS The presenting symptoms of cervical eosinophilic granuloma are usually pain and restricted range of motion. In contrast to eosinophilic granuloma of the thoracic spine and lumbar spine, the neurologic symptoms are less frequent, and the first radiographic sign is an osteolytic lesion. Vertebra plana is a rare sign in cervical eosinophilic granuloma. In children, the middle cervical spine is most often affected, whereas in adults it is the second vertebra. The outcome of the patients has been good in most cases, independently of treatment. CONCLUSION In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy. If the process continuous to progress, radiotherapy is recommended. Surgical treatment should be reserved for cases with instability or neurologic defects.
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Affiliation(s)
- Christoph Bertram
- Department of Traumatology, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
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27
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Benslama L. [Eosinophilic ulcer of the oral mucosa]. Ann Dermatol Venereol 2002; 129:853-4. [PMID: 12218910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
An unusual presentation of eosinophilic granuloma (EG) of the bilateral temporal bone in a 2-year-old male child is discussed with the literature review. Involvement of the temporal bone is relatively uncommon and otorrhea or symptoms resembling mastoiditis are nonspecific. This rare condition should be kept in mind in differential diagnosis of otitis media refractory to medical therapy.
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Affiliation(s)
- Sertac Yetiser
- Department of ORL and HNS, Gulhane Medical School, Etlik 06018, Ankara, Turkey.
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Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Takahashi J, Ohtsuka K. Eosinophilic granuloma of the spine: early spontaneous disappearance of tumor detected on magnetic resonance imaging. Case report. J Neurosurg 2000; 93:312-6. [PMID: 11012067 DOI: 10.3171/spi.2000.93.2.0312] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Two cases of eosinophilic granuloma (EG) of the spine associated with neurological deficits are presented. The patients were treated conservatively by using external fixation with a brace as well as bed rest. Neurological deficits and pain diminished and finally disappeared as the tumor mass decreased in size, as seen on magnetic resonance (MR) imaging. During the 5-year follow-up period no recurrence of the tumors was detected on MR images. Surgical treatment for spinal EG in children presenting with typical vertebra plana is not recommended except for those with severe or progressive palsy and for those in whom the disease requires differential diagnosis.
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Affiliation(s)
- M Kamimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
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Abstract
A solitary eosinophilic granuloma of the central nervous system is an unusual manifestation of histiocytosis X. A unique case of a solitary eosinophilic granuloma of the right temporal lobe without osseous involvement is described. A 20-year-old man presented with a grand mal seizure. Magnetic resonance imaging demonstrated an intraaxial enhancing mass in the right temporal lobe with marked vasogenic edema. A right temporal craniotomy was performed for resection of the lesion and the diagnosis of an eosinophilic granuloma was confirmed by histopathology. Follow-up MR imaging obtained 5 years following resection demonstrated no recurrence. Solitary eosinophilic granuloma should be considered in the differential diagnosis of enhancing mass lesions affecting the central nervous system. Although the natural history of solitary eosinophilic granulomas remains poorly defined, surgical treatment still remains the mainstay of therapy for these unifocal cerebral lesions.
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Affiliation(s)
- G A Grant
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
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31
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Ardekian L, Peled M, Rosen D, Rachmiel A, Abu el-Naaj I, Laufer D. Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87:238-42. [PMID: 10052382 DOI: 10.1016/s1079-2104(99)70279-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.
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Affiliation(s)
- L Ardekian
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel
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32
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Ie S, Quiniones B. Eosinophilic granuloma. J La State Med Soc 1998; 150:642-3. [PMID: 9926706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- S Ie
- Department of Medicine, Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine in New Orleans, USA
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Schreuder HW, Pruszczynski M, Lemmens JA, Veth RP. Eosinophilic granuloma of bone: results of treatment with curettage, cryosurgery, and bone grafting. J Pediatr Orthop B 1998; 7:253-6. [PMID: 9810523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Intralesional instillation of steroids is currently the first choice of treatment for eosinophilic granuloma of bone. However, some lesions fail to respond or are unsuitable for injection therapy due location, pending pathologic fracture, and soft tissue intrusion. The authors treated six patients with these lesion characteristics using curettage, cryosurgery, and bone grafting. After a mean follow-up of 34.3 months, all lesions healed completely, although one femoral fracture occurred 8 months after the operation. In selected cases of eosinophilic granuloma of bone, a primary surgical treatment seems feasible. The use of cryosurgery as adjuvant treatment extends the surgical margin and is of value in averting local recurrence.
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Affiliation(s)
- H W Schreuder
- Department of Orthopaedics, University Hospital Nijmegen, The Netherlands
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Abstract
STUDY DESIGN In this study, 14 conservatively treated patients were reviewed who had eosinophilic granuloma of the spine, which had been diagnosed on the basis of histologic study of the vertebral lesion or of specimens from other sites in patients with multiple involvement. The remodeling of the vertebral body was studied in an average follow-up of 5.6 years. OBJECTIVES To analyze the remodeling process of the involved growing vertebral body in Langerhans Cell Histiocytosis after conservative treatment and to assess the sagittal and frontal profile of the spine at the end of growth. Fourteen patients, aged between 1.2 and 11.3 years, with spinal involvement of a Langerhans' cell histiocytosis were treated in the department of orthopedics between 1980 and 1990. All patients had immobilization of the affected region by a custom-made brace. Six patients with symptomatic lesions had radiotherapy and four patients with disseminated disease were treated with chemotherapy. Clinical and radiologic examinations were made at regular intervals to evaluate the development of the vertebrae during the remodeling process. SUMMARY OF BACKGROUND DATA In the 14 patients, both sexes were affected equally. The disease was located in the cervical spine in two patients and in thoracic and lumbar vertebrae in seven patients each. Two patients had two vertebral lesions. METHODS The radiologic evolution of the 16 vertebral lesions was evaluated using follow-up standardized lateral radiographs. The reconstitution of the vertebral height in the presence of vertebra plana was calculated by measuring the ventral distance between the superior and inferior margins of the vertebral body in relation to the adjacent uninvolved vertebra. RESULTS The measurements showed a growth rate of 1.5-6 (average, 3) in vertebrae with vertebra plana and a growth rate of 1.1-2.7 (average, 1.4) in the unaffected vertebra. The reconstitution of the vertebral height was between 18.2% and 63.8% of the adjacent vertebrae before and between 72.2% and 97% after skeletal maturity. CONCLUSIONS The results demonstrate that conservative orthopedic treatment with immobilization in a brace is sufficient to allow for optimal vertebral remodeling. Partial to nearly complete reconstitution of vertebral height was seen in all cases. Thus, operative treatment with curettage of the lesion and bone grafting including multisegmental fusion with instrumentation is not necessary. In instances with neurologic impairment, rarely seen in adults, surgical decompression and short fusion of the spine is necessary. Nevertheless, complete staging and biopsy are mandatory for an accurate diagnosis.
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Affiliation(s)
- P Raab
- Department of Orthopaedic Surgery, University of Würzburg, Germany
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35
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Yasko AW, Fanning CV, Ayala AG, Carrasco CH, Murray JA. Percutaneous techniques for the diagnosis and treatment of localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone). J Bone Joint Surg Am 1998; 80:219-28. [PMID: 9486728 DOI: 10.2106/00004623-199802000-00009] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We retrospectively studied the outcome of percutaneous needle biopsy and intralesional injection of a corticosteroid (methylprednisolone) in thirty-nine patients who had localized Langerhans-cell histiocytosis (eosinophilic granuloma of bone). All thirty-nine patients had a solitary symptomatic lesion at presentation; a second lesion developed in two patients, two and four months after the first lesion was diagnosed. Therefore, there were forty-one lesions in thirty-nine patients. Fine-needle aspiration with or without core-needle biopsy was performed for all forty-one lesions, and the diagnosis of Langerhans-cell histiocytosis was established for thirty-seven (90 per cent). A corticosteroid was injected into thirty-five lesions. Twenty-nine received the injection at the time of the fine-needle aspiration on the basis of the cytological findings in the aspirate. Six patients who had a solitary lesion had a two-stage procedure because the injection was delayed until the diagnosis was confirmed with histological evaluation of specimens obtained by core-needle biopsy. Thirty-four (97 per cent) of the thirty-five lesions healed. The clinical symptoms associated with thirty-one lesions resolved within two weeks after a single injection of the corticosteroid. There were no complications associated with either the biopsy or the injection. At a median of ninety months (range, twenty-four to 199 months), no patient had recurrence of symptoms or of radiographic evidence of the lesion. All patients who had been managed with an intralesional injection of the corticosteroid had full range of motion of the affected extremity and had resumed unlimited activities. Although the mechanism of action of intralesional injection of a corticosteroid has not been defined, use of percutaneous needle biopsy to diagnose localized Langerhans-cell histiocytosis and treatment with intralesional administration of methylprednisolone relieved pain expeditiously, enabled the patient to avoid an operative procedure, and resulted in osseous healing. The specific role of corticosteroid therapy remains to be determined by prospective, randomized studies.
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Affiliation(s)
- A W Yasko
- University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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36
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Mammano S, Candiotto S, Balsano M. Cast and brace treatment of eosinophilic granuloma of the spine: long-term follow-up. J Pediatr Orthop 1997; 17:821-7. [PMID: 9591990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Eosinophilic granuloma of the skeleton is rarely reported in the literature. The incidence of vertebral involvement varies between 7.8 and 25% and it is generally a solitary lesion, with a predilection for the male sex in the first decade of life. The prognosis is favorable also for the vertebral body's tendency for reconstruction. A recovery of the somatic structure is apparently much improved by eliminating or reducing mechanical stress by means of bed rest and the use of plaster casts or braces. We examined nine patients treated at the Orthopedics Clinic of Padova University, and with a follow-up of > or = 10 years. treated with plaster casts and spinal orthoses. The study was based on the modified Nesbit radiographic classification in 4 grades of severity depending on the height of the vertebral body involved. Long-term follow-up revealed no painful symptoms and a virtually total recovery of somatic structure in five cases, whereas four patients still showed a varying degree of somatic alteration. The osteogenic capacity of the intact ring epiphysis and ossifying metaplastic processes were assumed to be the mechanisms contributing, together with a reduced mechanical load, to reconstruction of the vertebral somatic structure.
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Affiliation(s)
- S Mammano
- Institute of Orthopaedics, University of Padova, Italy
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37
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Robert M, Marty-Double C. [Lymph node eosinophilic granuloma. Apropos of 2 cases of Langerhans-cell histiocytosis with isolated lymph node involvement]. Arch Anat Cytol Pathol 1997; 44:237-40. [PMID: 9339010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report two cases of isolated lymph node involvement by Langerhans' cell histiocytosis which affected two young children. The histologic aspect reveals that lymph nodes have been modified by a proliferation of large histiocyte-like cells, associated with eosinophils. An immunohistochemical study on paraffin sections and for one case on frozen sections, reveals the usual phenotype of Langerhans' cells: these cells stain positively with S 100 protein and CD1 and are negative for both lysozyme and al antichymotrypsine. After a period of two years for one child and four years for the other, these children are in total remission, one spontaneously, the other after chemotherapy.
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Affiliation(s)
- M Robert
- Laboratoire d'Anatomie Pathologique, Hôpital Gaston Doumergue, Nîmes
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38
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Abstract
Twenty patients treated for eosinophilic granuloma of the spine were studied. Only 40% demonstrated the classical radiographic picture of vertebra plana. In 60% a lytic lesion of the vertebral body or the posterior elements was found. Seven patients underwent surgery; the indications were neurological involvement or failure of the biopsy to disclose the diagnosis. At an average follow-up period of 7 years, 17 patients are well and alive with no residual spinal pain, neurological compromise, recurrent disease, or extraskeletal involvement. Vertebral body collapse underwent some regeneration but did not regain full body height. In several patients this resulted in a local deformity. In patients with unifocal spinal eosinophilic granuloma, watchful observation with no treatment other than spinal support is warranted. In patients with neural involvement or multifocal lesions, a more active treatment, including surgery, may be indicated.
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Affiliation(s)
- Y Floman
- Spinal Surgery Unit, Hadassah University Hospital, Jerusalem, Israel
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39
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Feugier P, Guerci A, Nafissi S, Lederlin P. [Uni- and multifocal eosinophilic granulomas in adults. Diagnostic and therapeutic approaches. Apropos of 3 cases]. Rev Med Interne 1996; 17:924-8. [PMID: 8977973 DOI: 10.1016/0248-8663(96)88122-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Unifocal and multifocal eosinophilic granuloma are Langerhans cell histiocytosis of unknown cause. Over the last 10 years, recent insights in pathogenesis and characterization of this pathology have been made. The authors report three cases of adult unifocal and multifocal eosinophilic granuloma. A review of literature underlines diagnostic features and therapeutic aspects of this disease.
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Affiliation(s)
- P Feugier
- Service de médecine A, CHRU de Nancy-Brabois, Vandaeuvre-lès-Nancy, France
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40
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Burchard GD, Reimold-Jehle U, Bürkle V, Kretschmer H, Vierbuchen M, Racz P, Lo Y. Splenectomy for suspected malignant lymphoma in two patients with loiasis. Clin Infect Dis 1996; 23:979-82. [PMID: 8922789 DOI: 10.1093/clinids/23.5.979] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Intrasplenic lesions can cause diagnostic difficulties because malignant diseases can be excluded only by histologic examination. We present the cases of two patients with splenic manifestations of loiasis. Both patients had visited central Africa. Several years later, intrasplenic lesions were found during routine examinations (for chest trauma and employment, respectively). Both patients underwent splenectomies because malignant lymphoma was suspected. In both cases, histologic examination of the spleen showed eosinophilic granulomata with multiple Loa loa microfilariae.
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Affiliation(s)
- G D Burchard
- Institute for Tropical Medicine, University of Tübingen, Germany
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41
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Affiliation(s)
- S Uckan
- Department of Oral and Maxillofacial Surgery, Selcuk University, Konya, Turkey
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Lieberman PH, Jones CR, Steinman RM, Erlandson RA, Smith J, Gee T, Huvos A, Garin-Chesa P, Filippa DA, Urmacher C, Gangi MD, Sperber M. Langerhans cell (eosinophilic) granulomatosis. A clinicopathologic study encompassing 50 years. Am J Surg Pathol 1996; 20:519-52. [PMID: 8619419 DOI: 10.1097/00000478-199605000-00001] [Citation(s) in RCA: 236] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We summarize our experience with 238 cases of Langerhans cell granulomatosis (LCG), 198 of whom were followed for a median period of 10.5 years. Our patients did well unless overtreated, and no deaths were attributed to the disorder itself. The disease may appear in unifocal or multifocal form, and treatment is based on this fact. Virtually all patients recovered completely except for occasional residual orthopedic problems or residual diabetes insipidus. Several of the patients underwent subsequent pregnancies without difficulty. The granulomas primarily occur in bone, but lung, skin, and lymph nodal involvement is not uncommon. Involvement of thyroid, thymus, and other sites is rare. The hallmark of the disease is the accumulation of Langerhans cells (LCs). We review the pathology of LCG by histology, electron microscopy, and immunolabeling. LCs originally were identified in squamous epithelium, but these cells are part of the widespread system of dendritic cells. The latter cells, which arise from CD34+ progenitors, are specialized and efficient antigen-presenting cells for T-cell-mediated immunity. In LCG, however, the major associated cells are not T cells, but mature eosinophils: hence the original name eosinophilic granuloma. Confusion about terminology has been based upon the scanty and rather crude pathology reports in the original literature. The term histiocytosis X was meant to cover a spectrum of three diseases--eosinophilic granuloma, Hand-Schüller-Christian disease (HSC), and Letterer-Siwe disease (LS)--but HSC and LS have no basis in pathology and hence the terms are meaningless. The term HSC has become a synonym for multifocal eosinophilic granuloma (LCG). The term LS has been used in reporting a number of benign, malignant, or unknown conditions. We prefer the term LCG to avoid confusion with the term histiocytosis X because there is evidence that the LC is not a member of the mononuclear phagocyte system and hence not a tissue macrophage, and because the use of the term "histiocyte" has become a convenience in much of the literature when reporting incompletely understood diseases.
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Affiliation(s)
- P H Lieberman
- Department of Pathology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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43
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Gitelis S, Wilkins R, Conrad EU. Benign bone tumors. Instr Course Lect 1996; 45:425-446. [PMID: 8727761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- S Gitelis
- Rush Medical College, Chicago, Illinois, USA
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44
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Igarashi T, Nakagawa A, Nishino M, Murakami S, Ohouchi H, Koseki T, Yoshida Y, Hoshino H, Imai Y, Abe S. [Improvement of pulmonary eosinophilic granuloma after smoking cessation in two patients]. Nihon Kyobu Shikkan Gakkai Zasshi 1995; 33:1125-9. [PMID: 8544386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We encountered two cases in which pulmonary eosinophilic granuloma improved after cessation of smoking. The patient in case 1 was a 39-year-old woman. She smoked 10-15 cigarettes a day for 20 years. The patient in case 2 was a 19-year-old man. He smoked a pack of cigarettes a day for 5 years. CT revealed cystic lesions and small nodular lesions predominantly in the upper and middle lung fields. Diagnosis was made by thoracoscopic lung biopsy in case 1 and by transbronchial lung biopsy in case 2. After smoking cessation, symptoms, CT findings, and vital capacity of both patients improved remarkably. Smoking cessation may have been related to the improvement in these patients.
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Affiliation(s)
- T Igarashi
- Department of Respiratory Medicine, Kushiro City General Hospital, Hokkaido, Japan
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45
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Marafioti T, Cardia E. Solitary eosinophilic granuloma of cerebral lobes. Value of immunohistochemistry for a diagnostic interpretation. Zentralbl Pathol 1994; 140:391-6. [PMID: 7826988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primary cerebral eosinophilic granuloma is a very rare lesion. In this study we report a further observation of solitary fronto-parietal eosinophilic granuloma in a child of three years. The immunohistochemical pattern, with the strong positivity of the histiocytic cells for PG-M1, an antibody which does not stain the Langerhans cells, suggests the reactive nature of the granulomatous lesion.
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Affiliation(s)
- T Marafioti
- Department of Human Pathology, University of Messina, Italy
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46
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Abstract
Forty children who had Langerhans-cell histiocytosis were followed for an average of six years (range, excluding patients who died of the disease, two to fifteen years). The patients were divided into two diagnostic groups: those who had localized disease (involving one bone or more only) and those who had multifocal disease (an osseous lesion and a soft-tissue mass, a skin rash, diabetes insipidus, or generalized disease). Methods of treatment included curettage, bone-grafting, chemotherapy, local or systemic corticosteroids, and radiotherapy. Nineteen of the thirty patients who had localized disease had a complete response to the therapy, four had a partial response, and seven had no response. Twenty-one of these thirty patients had not had a recurrence by the time of the latest follow-up examination; nine had a local recurrence within four years after the initial therapy but had no additional recurrences after treatment of the local recurrence. No recurrence occurred more than four years after the time that the initial diagnosis had been made. Five of the ten patients who had multifocal disease had a complete response to the therapy, two had a partial response, and three had no response. Six patients had a recurrence; four did not. Two patients died of the disease. As a result of this study, we recommend the avoidance of intensive measures of treatment, if possible, and we advise long-term follow-up of these patients.
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Affiliation(s)
- S Sessa
- Department of Pediatric Surgery, Children's Hospital, Nancy, France
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47
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Cardon T, Hachulla E, Flipo RM, Chastanet P, Rose C, Deprez X, Duquesnoy B, Delcambre B, Devulder B. Percutaneous vertebroplasty with acrylic cement in the treatment of a Langerhans cell vertebral histiocytosis. Clin Rheumatol 1994; 13:518-21. [PMID: 7835021 DOI: 10.1007/bf02242955] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 25-year-old man developed multiple eosinophilic granuloma of bone including vertebral and sacral localization. Radiotherapy was initially administered. One year later, a relapse occurred in another vertebrae which was previously irradiated. Percutaneous vertebroplasty was, for the first time to our knowledge performed, in this indication, with a good clinical result with follow-up now for one year. We emphasize that such treatment is permissible only in symptomatic, progressive lesions, with threatened decompensation of spinal stability. This technique should be used only on an adult.
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Affiliation(s)
- T Cardon
- Department of Internal Medicine, University of Lille, France
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48
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Bandlow P, Köhler HP. [Lumbar eosinophilic granuloma with extensive paravertebral soft tissue infiltration]. Aktuelle Radiol 1994; 4:149-52. [PMID: 8049284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The present paper describes a case of eosinophilic granuloma of the lumbar spine. The lesion affected multiple spinal levels and was accompanied by an extensive paravertebral soft-tissue mass. HR-CT scans revealed additional pulmonary histiocytosis X.
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Affiliation(s)
- P Bandlow
- Abteilungen für Röntgendiagnostik, Georg-August-Universität Göttingen
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49
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Yang JT, Chang CN, Lui TN, Ho YS. Eosinophilic granuloma of the skull--report of four cases. Changgeng Yi Xue Za Zhi 1993; 16:257-62. [PMID: 8313210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eosinophilic granuloma is a benign form of the three clinical variants of histiocytosis-X. It is an uncommon, localized granulomatous process, forming solitary or multiple lytic skeletal lesions, and primarily involving male children and young adults. We studied 4 cases, three boys and one girl, aged 4, 8, 27 and 12 years, in Chang Gung Memorial Hospital from 1981 to 1990. Their common presentation was the rapidly growing, painful, and protruding scalp masses without neurological deficits. En bloc excisions of these lesions were performed. Then radiotherapy was given postoperatively in two cases, chemotherapy in one, and no adjuvant treatment in one. During their follow-up period of 2 to 10 years, all 4 patients were well, without evidence of recurrence.
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Affiliation(s)
- J T Yang
- Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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50
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Herrero Payo JA, Ruiz Rubio JL, Montans Arauso J, Romero Cacigal I, Méndez Rubio S, Quijano Barroso P, Acebal Lucia J, Montes Diaz MJ, Paez Borda A, Fernández Gonzalez I. [Eosinophilic cystitis]. ARCH ESP UROL 1993; 46:673-6. [PMID: 8311516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.
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Affiliation(s)
- J A Herrero Payo
- Servicio de Urología y Anatomía Patológica, Hospital Universitario de Getafe, Madrid, España
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