Eosinophilic granuloma of the skull associated with epidural haematoma: a case report and review of the literature

Abstract

The acute presentation of a solitary EG of the skull with an epidural haematoma was described in only four cases in the literature. This is the first documented case in terms of the origin of an epidural haematoma.

Eosinophilic Granuloma Presenting as an Epidural Hematoma and Cyst

“…The authors of these studies speculated that the possible mechanisms for the development of epidural hematoma were rupture of the tumor cyst, communicating with the epidural vein and the sinus pericranii 5) and trauma related intratumoral hemorrhage, which subsequently penetrated into the epidural space 1,3,6,7) . All five cases except our case had occipital lesions, and four of the six patients had a previous history of head trauma.…”

“…EG, the mildest form of LCH, is usually benign and accounts for 70% of all cases of LCH. HandSchüller-Christian disease and Letterer-Siwe syndrome represent multifocal EGs and a malignant fulminant lymphomatous disease of infancy, respectively 7) . The most common presentation of EG is a painful, immobile scalp mass in the parietal and frontal bones.…”

“…Patients typically present with a tender enlarging skull mass with an area of bone destruction underneath, which is surrounded by poorly circumscribed, but sharply defined margins on skull x-ray. The course is benign with a tendency towards spontaneous regression, but recurrences may also occur 7) . The acute presentation of a Langerhans' cell histiocytosis (LCH) is a rare immunologic disorder characterized by histiocyte proliferation in multiple organ systems.…”

“…It is a painless, destructive bone lesion that frequently involves the skull (in 43-80% of cases), followed by the femur, mandible, and ribs 7) . Patients typically present with a tender enlarging skull mass with an area of bone destruction underneath, which is surrounded by poorly circumscribed, but sharply defined margins on skull x-ray.…”

A reply to the letter to the editor by Nima Derakhshan and Mahsa Roshanfarzad with regard to the paper “Pandora’s box: eosinophilic granuloma at the cerebellopontine angle—should we open it?”

“…Eosinophilic granuloma (EG) is a focal disease form of Langerhans cell histiocytosis (LCH) presenting in the skull, femur, vertebrae, pelvis, mandible, and ribs; yet, multiple sites of occurrence have been described in the literature with confirmation of the pathology [2][3][4][5].…”