Eosinophilic granuloma

Abstract

Localised Langerhans-cell histiocytosis of bone (eosinophilic granuloma) is a benign tumour-like condition with a variable clinical course. Different forms of treatment have been reported to give satisfactory results. However, previous series all contain patients with a wide age range. Our aim was to investigate the effect of skeletal maturity on the rate of recurrence of isolated eosinophilic granuloma of bone excluding those arising in the spine. We followed up 32 patients with an isolated eosinophilic granuloma for a mean of five years; 17 were skeletally immature. No recurrences were noted in the skeletally immature group even after biopsy alone. By contrast, four of 13 skeletally mature patients had a recurrence and required further surgery. This suggests that eosinophilic granuloma has a low rate of recurrence in skeletally immature patients.

Current concepts for the diagnosis and management of eosinophilic granuloma of bone

“…CT-guided biopsy for eosinophilic granuloma has been effective for histological diagnosis, with low morbidity and a diagnostic accuracy of 70–100 % [5, 31–38]. Although anecdotally excellent results with biopsy alone have been previously reported for patients with eosinophilic granulomas [39], biopsy should not be considered as a strategy for treatment of these patients but rather as a step to confirm diagnosis [26, 32, 33, 36–38, 40–42]. …”

“…Since eosinophilic granuloma in children is known to resolve spontaneously with time, observation alone or biopsy alone to confirm the diagnosis have also been recommended as a treatment strategy [39]. A previous study reported spontaneous resolution without recurrence of the lesions in six skeletally immature patients that had biopsy followed by observation alone (open biopsy in three and percutaneous in three), suggesting the intriguing possibility that surgery may result in a higher rate of recurrence than less aggressive procedures [39].…”

“…A previous study reported spontaneous resolution without recurrence of the lesions in six skeletally immature patients that had biopsy followed by observation alone (open biopsy in three and percutaneous in three), suggesting the intriguing possibility that surgery may result in a higher rate of recurrence than less aggressive procedures [39]. We concur that biopsy may have an effect on bone healing and eosinophilic granuloma lesions reconstitution [39]. However, we disagree that patients, especially children with symptomatic bone lesions should be left alone to let the disease take its natural course without a histological diagnosis.…”

Eosinophilic Granuloma Arising from the Sacrum: A Case Report

“…Regarding the location of osseous eosinophilic granulomas, the flat bones are involved in 70% of tumors, and the long bones in 30% [10]. Among the flat bones, eosinophilic granulomas predominantly affect the skull, pelvis, vertebrae, mandible, and ribs [1,8]. However, to the best of our knowledge, only one report has previously described this type of tumor in the sacrum [11].…”

“…Eosinophilic granuloma is a benign tumor-like condition characterized by a clonal proliferation of Langerhans-type histiocytes in the bone or lung [1,2]. Eosinophilic granuloma of bone was initially described in 1940 [3,4], and its reported incidence is currently 0.05 -0.5 per 100,000 children per year, with 90% of tumors occurring under the age of 15 years [5][6][7][8][9].…”