Solitary tibial lesion as the initial presentation of Langerhans cell histiocytosis: report of two cases and literature review

Abstract

The various presentations of osseous Langerhans cell histiocytosis (LCH) make it difficult to distinguish from other bone diseases. In addition, there is no universally accepted protocol for managing osseous LCH for single non-central nervous system-risk lesions. Here, the rare cases of two paediatric patients, aged 1 and 2 years, who presented with a solitary tibial lesion at time of LCH diagnosis, are reported. One patient progressed to multiple lesions after curettage of the original lesion. Subsequently, both patients received preventive chemotherapy using the Taiwan Paediatric Oncology Group (TPOG) revised protocol for treating low risk patients with LCH, namely, TPOG LCH2002-LR. After receiving this treatment, which included a schedule of prednisolone and vincristine for 6 weeks, followed by prednisolone, vincristine and 6-mercaptopurine for a further 48 weeks, both patients are free from recurrence or progression.

Multifocal eosinophilic granuloma with femoral epiphyseal lesion mimicking an aneurysmal bone cyst

“…EG frequently presents as a solitary lesion; even though a polyostotic form has been described. It involves the axial skeleton and diaphysis long bones as well as the soft tissues adjacent to the bone causing localized bone pain and tender soft tissue swelling [4] . It has a slight male predominance most commonly affecting the children and young adults; however, it can rarely be seen in adults [5] , [6] , [7] .…”