Spontaneous Resolution of Calvarial Eosinophilic Granuloma in Children

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.

Nonoperative management of solitary eosinophilic granulomas of the calvaria

“…While spontaneous remission has been reported previously, 11 there is no standardized approach to the management of unifocal calvarial EG. Treatment includes surgical curettage or excision, intralesional steroid therapy, radiation therapy, and systemic medications like indomethacin, bisphosphonates, and chemotherapy.…”

Thigh Pain in an 18-year-old Man

“…Spontaneous regression of lesions has been reported in multiple studies [4,17,22]. The lesions rarely recur after treatment, although it has been suggested that an eosinophilic granuloma in adults may represent a more aggressive form of the disease and be associated with a higher relapse rate [18].…”

Unusual Acute Onset of Symptomatic Langerhans Cell Histiocytosis of the Skull: Case Report and Literature Review

“…Other symptoms, such as seizures and those related to mass effect and increased intracranial pressure depend on the site and volume of the space-occupying lesion. Initial growth of calvarial st, plateaus in adults, and may even spontaneously resolve [12]. Patients with skull metastases tend to present with a shorter history of symptoms.…”

“…Stark et al found an average duration of symptoms of 2 months for skull metastases vs. 18 months for primary skull lesions [1]. Calvarial eosinophilic granuloma has been reported to spontaneously resolve in 4 out of 17 children with a tender calvarial mass [12]. These masses had enlarged rapidly over days and resolved within weeks, with no recurrence at follow-up from 2 months up to 7 years.…”

“…These masses had enlarged rapidly over days and resolved within weeks, with no recurrence at follow-up from 2 months up to 7 years. These authors suggest that observation can be considered in children with solitary calvarial masses with radiographic features of EG, with sufficient delay in surgical intervention to allow time for spontaneous resolution [12]. However, surgery remains the best treatment [12][13][14] allowing for accurate diagnosis with tissue biopsy.…”