Intradural eosinophilic granuloma invading skull: Case report and review of the literature

Abstract

Eosinophilic granuloma is a localized form of Langerhans cell histiocytosis, most commonly involving the skeletal system. Their origin from the dura is rare with only a handful of cases on record. We present one such rare case of an eosinophilic granuloma originating from the dura mater with secondary osseous invasion in an 11-year-old female child who presented with a swelling in the right parietal region. Magnetic resonance imaging demonstrated an enhancing mass with a wide dural attachment with a lytic lesion in the overlying skull. Right parietal extended craniotomy was done with the excision of mass from the dura. Histopathological features of mass were characteristic of eosinophilic granuloma which was confirmed by positive immunohistochemical staining for CD1a.

Eosinophilic Granuloma as a Solitary Lytic Lesion of the Cervical Spine in a Child

“…Histopathology is confirmatory, with EG displaying scattered eosinophils (not necessary for diagnosis) and clusters/aggregates of lymphocytes, histiocytes, and hallmark Langerhan cells, often associated with areas of fibrosis. With passage of time, the lesion tends to be more fibrotic and less cellular, which may require ancillary tools such as IHC to highlight the scattered characteristic Langerhan cells [ 8 ]. Healed lesions become more sclerotic on radiographs or can entirely resolve.…”

A great mimicker of mastoiditis- Multisystem Langerhans’ cell histiocytosis

“…[3] Normal facial nerve landmarks can be obscured in LCH and hence facial nerve palsy is at risk. Aggressive LCH can expose the sigmoid sinus and dura, [16,17] thereby increasing the risk of a dura tear if operative management is chosen. LCH-MS-RO-with otologic involvement responded well to Stratum II chemotherapy consisting of cytarabine, vincristine and prednisolone.…”

Dural involvement in central nervous system langerhans cells histiocytosis (LCH) on FDG PET/CT: Case report and review of CNS manifestations of LCH on PET/CT

“…Contrast enhanced MRI is superior for assessing intracranial cerebellar and extra-axial or dural lesions signifying CNS involvement, although case reports are infrequent [ 3 , 19 , 13 , 20 , 21 ]. However, despite the superior resolution and delineation of CNS morphology on MRI, it and other conventional imaging may still be diagnostically challenging, especially when dural lesions and nonmass-like intra-axial disease exhibit imaging characteristics mimicked by other pathologies [22] , [23] , [24] , [25] .…”