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Prasad GL, Krishna G, Kale A, Rajeshwari M, Kale SS. Eosinophilic granuloma of the cervical spine in a young adult: A rare case report. Surg Neurol Int 2024; 15:198. [PMID: 38974539 PMCID: PMC11225499 DOI: 10.25259/sni_262_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/09/2024] [Indexed: 07/09/2024] Open
Abstract
Background Spinal eosinophilic granulomas (EG) are rare tumors, mostly reported in the pediatric age group. They constitute <1% of primary bone neoplasms, and cervical spine involvement is uncommon. Case Description A 20-year-old male presented with neck pain for a 4-month duration. Six years previously, he had received six cycles of vinblastine for biopsy-proven histiocytosis of an axillary lymph node; this resulted in incomplete remission. Present magnetic resonance/computed tomography (CT) imaging revealed a lytic C2 body lesion with atlantoaxial instability. When the CT-guided biopsy was suggestive of EG, he was managed with definitive surgery and adjuvant radiotherapy. Conclusion Cervical spine EG is rare in adults. CT-guided biopsy should confirm the diagnosis and should be followed by definitive surgery and adjuvant radiotherapy.
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Affiliation(s)
- G. Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Gopal Krishna
- Department of Neurosurgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ameya Kale
- Department of Neurology, Connecticut University, Connecticut, United States
| | - Madhu Rajeshwari
- Department of Pathology All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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2
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Lou Y, Zhao C, Cao H, Yan B, Chen D, Jia Q, Li L, Xiao J. Multiple Langerhans cell histiocytosis with spinal involvement. Bone Joint J 2023; 105-B:679-687. [PMID: 37257861 DOI: 10.1302/0301-620x.105b6.bjj-2022-1129.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS). Methods We included 28 patients with multiple LCH involving the spine treated between January 2009 and August 2021. Kaplan-Meier methods were applied to estimate overall survival (OS) and PFS. Univariate Cox regression analysis was used to identify variables associated with PFS. Results Patients with multiple LCH involving the spine accounted for 15.4% (28/182 cases) of all cases of spinal LCH: their lesions primarily involved the thoracic and lumbar spines. The most common symptom was pain, followed by neurological dysfunction. All patients presented with osteolytic bone destruction, and 23 cases were accompanied by a paravertebral soft-tissue mass. The incidence of vertebra plana was low, whereas the oversleeve-like sign was a more common finding. The alkaline phosphatase was significantly higher in patients with single-system multifocal bone LCH than in patients with multisystem LCH. At final follow-up, one patient had been lost to follow-up, two patients had died, three patients had local recurrence, six patients had distant involvement, and 17 patients were alive with disease. The median PFS and OS were 50.5 months (interquartile range (IQR) 23.5 to 63.1) and 60.5 months (IQR 38.0 to 73.3), respectively. Stage (hazard ratio (HR) 4.324; p < 0.001) and chemotherapy (HR 0.203; p < 0.001) were prognostic factors for PFS. Conclusion Pain is primarily due to segmental instability of the spine from its destruction by LCH. Chemotherapy can significantly improve PFS, and radiotherapy has achieved good results in local control. The LCH lesions in some patients will continue to progress. It may initially appear as an isolated or single-system LCH, but will gradually involve multiple sites or systems. Therefore, long-term follow-up and timely intervention are important for patients with spinal LCH.
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Affiliation(s)
- Yan Lou
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Chenglong Zhao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Haotian Cao
- Department of Pathology, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Bing Yan
- Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Dingbang Chen
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Qi Jia
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Lin Li
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai, China
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3
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Angelini A, Mosele N, Gnassi A, Baracco R, Rodà MG, Cerchiaro M, Ruggieri P. Vertebra Plana: A Narrative Clinical and Imaging Overview among Possible Differential Diagnoses. Diagnostics (Basel) 2023; 13:diagnostics13081438. [PMID: 37189540 DOI: 10.3390/diagnostics13081438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H-Histiocytosis; E-Ewing's sarcoma; I-Infection; G-Giant cell tumor; H-Hematologic neoplasms; T-Tuberculosis; O-Osteogenesis imperfecta; F-Fracture; H-Hemangioma; O-Osteoblastoma; M-Metastasis; O-Osteomyelitis, chronic.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nicolò Mosele
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andrea Gnassi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Riccardo Baracco
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Maria Grazia Rodà
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
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4
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Englert EG, Daley E, Metcalf B, Zaltz I, Khalil J, Settecerri JJ. Langerhans Cell Histiocytosis in the Pediatric Spine Requiring Stabilization: A Literature Review and Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202306000-00055. [PMID: 37319308 DOI: 10.2106/jbjs.cc.22.00450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
CASE This report describes 3 cases of Langerhans cell histiocytosis (LCH) of the cervical and thoracic spine in patients aged 4 to 10 years. Each patient had painful lytic spinal lesions with vertebral body collapse and posterior involvement suggesting instability requiring corpectomy, grafting, and fusion. All 3 patients were doing well at their most recent follow-up without pain or recurrence. CONCLUSION Although LCH of the pediatric spine is usually successfully treated non-operatively, we recommend corpectomy and fusion when there is instability of the spinal column and/or severe stenosis. Posterior element involvement occurred in all 3 cases and may lead to instability.
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Affiliation(s)
| | - Erika Daley
- Riley Children's Health, Indianapolis, Indiana
| | | | - Ira Zaltz
- Beaumont Hospital, Royal Oak, Michigan
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5
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Erdogan K, Solmaz S, Dogan I. First technical report of a pediatric case with thoracic Langerhans cell histiocytosis: Gross total tumor removal, corpectomy, and 360° stabilization via posterolateral approach at a single stage. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:236-239. [PMID: 34728989 PMCID: PMC8501817 DOI: 10.4103/jcvjs.jcvjs_142_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Langerhans cell histiocytosis (LCH) is a rare nonmalignant disease characterized by a clonal proliferation of mononuclear cells called Langerhans histiocytes and infiltrates surrounding tissues, mostly self-limiting and usually occurring in the first two decades of life. Vertebral involvement is rare, mostly seen in the thoracic region, and involves the anterior elements of the corpus. In the literature, several treatment options and surgical approaches have been reported concerning the treatment of this disease and surgery. Case Presentation: We report an 18-month-old male with thoracic LCH who underwent surgery due to progressive neurological deficit. Gross total removal of the tumor with one level corpectomy in this patient was achieved via a posterolateral approach with postoperative functional improvement. The surgical cavity was supported by corpectomy cage and unilateral screw-rod fixation system at the same stage. Conclusion: Gross total tumor removal, corpectomy, and 360° stabilization via posterolateral approach at a single stage are safe, effective, and definite neurosurgical methods in terms of providing neurological recovery, long-term tumor-free survival, and spinal stability.
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Affiliation(s)
- Koral Erdogan
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Serdar Solmaz
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, Ankara University School of Medicine, Ibn-i Sina Hospital, Ankara, Turkey
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6
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Chilloh S, Mannes I, Morelle G, Adamsbaum C. Pediatric idiopathic intervertebral disc calcification (IIDC): a challenging case. Skeletal Radiol 2021; 50:1473-1477. [PMID: 33483770 DOI: 10.1007/s00256-021-03713-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Idiopathic intervertebral disc calcification is a rare condition in children with a very good prognosis. As there are no biological markers, imaging is invaluable for diagnosing this "do not touch" lesion. While the characteristic feature is nucleus pulposus calcification at one or more cervical or thoracic levels, it is important that practitioners be able to recognize atypical patterns so that biopsy can be avoided. Here we report a case of pediatric idiopathic intervertebral disc calcification with contiguous vertebral involvement and anterior longitudinal ligament ossification.
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Affiliation(s)
- Sandrine Chilloh
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 78 rue du General Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Inès Mannes
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 78 rue du General Leclerc, 94270, Le Kremlin-Bicêtre, France
- Faculty of Medicine, Paris-Saclay University, 63 Rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France
| | - Guillaume Morelle
- Department of General Pediatrics, AP-HP, Bicetre Hospital, 78 rue du General Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 78 rue du General Leclerc, 94270, Le Kremlin-Bicêtre, France.
- Faculty of Medicine, Paris-Saclay University, 63 Rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France.
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7
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Histiocytosis in the pediatric spine: a clinical and radiographic analysis of 50 patients. Spine Deform 2021; 9:823-831. [PMID: 33400235 DOI: 10.1007/s43390-020-00261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN Descriptive, retrospective. Scientific level of evidence IV. OBJECTIVES The aim of this study was to evaluate a consecutive case series of 50 pediatric patients with LCH of the spine. Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of Langerhans cells in different organs. Incidence in children range from 2 to 10 cases per million. In the current literature, few series evaluate LCH in the pediatric spine. MATERIAL AND METHODS A consecutive case series of 50 pediatric patients with LCH of the spine treated at our hospital between 1984 and 2016, with a follow-up of at least 2 years, was analyzed. Sex, age, clinical and radiographic presentation, number of lesions, treatment, complications, and outcome were assessed. RESULTS Fifty patients, 26 boys and 24 girls, were evaluated. Mean age was 5 years and 2 months (6 months to 13 years and 3 months). 27 patients had a single spinal lesion while 23 had 2 or more lesions. A total of 100 vertebrae were involved. The thoracic spine was the most affected. The most frequent lesion location was in the vertebral body in 88% of the cases. The symptoms were pain (87%), reduced range of motion, deformity, and neurologic deficit. Biopsy was performed in 48 patients. Thirty-nine patients received medical treatment, 28 used orthoses and six required surgery. Six patients (12%) recurred at a mean of 3 years and 5 months (range 2-12 years). In all cases, neurological symptoms, torticollis, and deformities resolved after medical or surgical treatment. CONCLUSIONS Because of the variable presentation of the disease, ranging from a solitary isolated vertebral lesion to polyostotic and multisystemic involvement, a multidisciplinary team is required to have an adequate management of these patients and to obtain good results.
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8
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Yang IC, Lee GJ, Han MS, Lee SK, Moon BJ, Lee JK. Langerhans Cell Histiocytosis Involving Second Cervical Vertebra and the Hypothalamus and Pituitary in an Adult. World Neurosurg 2020; 142:142-146. [DOI: 10.1016/j.wneu.2020.06.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
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9
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Nguyen TT, Thelen JC, Bhatt AA. Bone up on spinal osseous lesions: a case review series. Insights Imaging 2020; 11:80. [PMID: 32601958 PMCID: PMC7324468 DOI: 10.1186/s13244-020-00883-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
Spinal osseous neoplasms are frequently encountered and can be challenging when present as solitary lesions. Familiarity with the range of benign and malignant spinal pathology can help the radiologist formulate a comprehensive differential diagnosis. This article focuses on the spectrum of extradural spinal tumors, accounting for the majority of primary spinal tumors, by comparing the epidemiology, pathophysiology, clinical presentation, and characteristic imaging appearance of these lesions. The discussion includes the commonly encountered benign lesions, such as vertebral venous vascular malformation and enostosis, as well as malignant lesions including metastases and lymphoma. The article also includes other less-encountered primary spinal tumors such as plasmacytoma, osteoid osteoma, osteoblastoma, giant cell tumor, eosinophilic granuloma, chordoma, chondrosarcoma, osteosarcoma, Ewing’s sarcoma, and angiosarcoma. Familiarity with the characteristic imaging features can help the radiologist reach an accurate diagnosis and obviate the need for unnecessary invasive procedures such as biopsy and surgery.
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Affiliation(s)
- Trinh T Nguyen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Jarett C Thelen
- University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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10
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Rothschild BM, Tanke D, Rühli F, Pokhojaev A, May H. Suggested Case of Langerhans Cell Histiocytosis in a Cretaceous dinosaur. Sci Rep 2020; 10:2203. [PMID: 32042034 PMCID: PMC7010826 DOI: 10.1038/s41598-020-59192-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/21/2020] [Indexed: 12/16/2022] Open
Abstract
Susceptibility to diseases is common to humans and dinosaurs. Since much of the biological history of every living creature is shaped by its diseases, recognizing them in fossilized bone can furnish us with important information on dinosaurs' physiology and anatomy, as well as on their daily activities and surrounding environment. In the present study, we examined the vertebrae of two humans from skeletal collections with Langerhans Cell Histiocytosis (LCH), a benign osteolytic tumor-like disorder involving mainly the skeleton; they were diagnosed in life, along with two hadrosaur vertebrae with an apparent lesion. Macroscopic and microscopic analyses of the hadrosaur vertebrae were compared to human LCH and to other pathologies observed via an extensive pathological survey of a human skeletal collection, as well as a three-dimensional reconstruction of the lesion and its associated blood vessels from a µCT scan. The hadrosaur pathology findings were indistinguishable from those of humans with LCH, supporting that diagnosis. This report suggests that hadrosaurids had suffered from larger variety of pathologies than previously reported. Furthermore, it seems that LCH may be independent of phylogeny.
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Affiliation(s)
- Bruce M Rothschild
- Indiana University, 2401W. University Ave., Muncie, IN, 47303, USA.
- Carnegie Museum, 4400 Forbes Ave., Pittsburgh, PA, 44272, USA.
| | - Darren Tanke
- Royal Tyrrell Museum of Palaeontology, 1500 N. Dinosaur Trail, Drumheller, AB, T0J 0Y0, Canada
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Ariel Pokhojaev
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Dan David Center for Human Evolution and Biohistory Research, Shmunis Family Anthropology Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila May
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Dan David Center for Human Evolution and Biohistory Research, Shmunis Family Anthropology Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Abstract
RATIONALE Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.
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12
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Eosinophilic Granuloma of the Cervical Spine in Adults: A Review. World Neurosurg 2019; 125:301-311. [DOI: 10.1016/j.wneu.2019.01.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
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13
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Nakashima K, Koga Y, Sakai Y, Takada H, Harimaya K, Ohga S, Taguchi T, Oda Y, Honda H, Ohga S. Radiotherapy for Langerhans cell histiocytosis with paraplegia: A rare oncologic emergency case report in infancy and literature review. Brain Dev 2018; 40:952-955. [PMID: 29907475 DOI: 10.1016/j.braindev.2018.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a clonal disease with focal or disseminated lesions that may compress the surrounding tissues, including the spinal cord. Because few reports have described the spinal symptoms as the first manifestation of pediatric LCH, the long-term neurological outcomes remain unclear. CASE REPORT AND LITERATURE REVIEW We report a 21-month-old boy who presented with sudden-onset paraplegia. Imaging analyses revealed that osteolytic lesions and epidural tumors compressing the spinal cord at the T7-9 vertebrae. Twelve days after he developed leg weakness, emergency radiotherapy was started after a tumor biopsy. During the course of radiotherapy, paralysis steadily ameliorated. After we excluded infections and determined the pathological diagnosis of LCH, multi-drug chemotherapy was started. Apparent improvement in his complete paraplegia was observed after a total 15 Gy of radiotherapy and subsequent chemotherapy, leaving no neurological sequelae at 4 years of age. Through a literature search of studies published from 1980 to 2017, we found that children with LCH showed a generally favorable recovery from neurological dysfunction after the acute phase of spinal symptoms. CONCLUSION This report underscores the utility of emergency radiotherapy for the neurological recovery of spinal LCH in infants. Our long-term observation further denotes the value of this treatment in terms of the intact survival with preserved motor functions and physical growth.
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Affiliation(s)
- Kentaro Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Saiji Ohga
- Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Batouli A, Gholamrezanezhad A, Petrov D, Rudkin S, Matcuk G, Jadvar H. Management of Primary Osseous Spinal Tumors with PET. PET Clin 2018; 14:91-101. [PMID: 30420225 DOI: 10.1016/j.cpet.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Knowledge of the PET imaging findings of osseous spinal neoplasms is essential, because they are common incidental findings on PET scans done for staging of unrelated primary malignancies. Additionally, PET can help differentiate lesions that are not clearly defined by anatomic modalities alone. PET can also be used for follow-up of aggressive tumors to assess response to treatment, often proving superior to CT or MR imaging alone for this purpose. This review discusses the role of PET/CT and PET/MR imaging in the diagnosis and management of primary benign and malignant osseous tumors of the spine.
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Affiliation(s)
- Ali Batouli
- Department of Radiology, Division of Neuroradiology, Oregon Health and Science University, 8833 Southwest 30th Avenue, Portland, OR 97219, USA.
| | - Ali Gholamrezanezhad
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - David Petrov
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - Scott Rudkin
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - George Matcuk
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - Hossein Jadvar
- Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA; Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
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15
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Clinical features and treatment outcomes of Langerhans cell histiocytosis of the spine. Spine J 2018; 18:1755-1762. [PMID: 29505854 DOI: 10.1016/j.spinee.2018.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Langerhans cell histiocytosis (LCH) of the spine is a relatively rare condition with unknown etiology. The diagnosis and treatment protocols for spine LCH remain controversial. PURPOSE In this study, we evaluated the efficacy and safety of our proposed diagnosis and treatment protocol introduced in 2009. STUDY DESIGN This is a retrospective study. PATIENT SAMPLE A total of 110 patients with spine LCH who had been diagnosed and treated in our hospital from October 1997 to November 2015 were included in this study. OUTCOME MEASURES The age, gender, symptoms, neurologic function, lesion distribution, radiological features, pathology, treatment, outcome, and treatment complications of the patients were collected. Visual analog scale (VAS) for pain and Frankel scale for neurologic status were also documented. METHODS We retrospectively reviewed 110 patients with spine LCH who had been diagnosed and treated in our hospital from October 1997 to November 2015. The indications for computed tomography (CT)-guided biopsy and surgery for spine LCH have become more stringent since 2009. In cases of a solitary spinal lesion, immobilization and observation were usually first suggested. Chemotherapy was suggested for cases with multifocal LCH lesions, and low-dosage radiotherapy was restricted to recurrent solitary lesion. This project was supported by our hospital (No. Y71508-01) (¥ 400,000). RESULT This series included 69 male and 41 female patients (age range, 1-52 years). Pain was the most common symptom (93.6%, 103/110). Pathologic diagnosis was achieved in 72 cases (65.5%). CT-guided biopsies were performed in 91.3% (42/46) and 73.2% (41/56) of cases before and after 2009, respectively (p=.02). Ninety-eight cases (89.1%) were followed up for a mean 66.3 (range, 24-159) months. Immobilization and observation were performed in 25.9% (14/54) and 75.0% (42/56) of cases before and after 2009, respectively (p<.001). Approximately 35.2% (19/54) and 10.7% (6/56) of cases had surgery (p=.002) before and after 2009, respectively. During the follow-up, no significant difference was found in the outcomes between the two groups treated before and after 2009 (p=.64). CONCLUSION Biopsy is not mandatory for typical spine lesions of LCH. Given the self-healing tendency of spine LCH, immobilization and observation remain the first-choice treatments for LCH lesions. Conservative biopsy and treatment protocols might be more appropriate for spinal LCH.
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Lan ZG, Richard SA, Lei C, Ju Y. Thoracolumbar Langerhans cell histiocytosis in a toddler. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Altano-axial subluxation with torticollis secondary to Langerhans cell histocytosis. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Bin K, Jacopin S, Poinsot E, Stoven C, Ruzic JC, Maurin S, Enaud E. [A lumbar vertebral eosinophilic granuloma with spinal instability in an adolescent]. Arch Pediatr 2017; 24:618-621. [PMID: 28583775 DOI: 10.1016/j.arcped.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
This is a case report of a rare isolated eosinophilic granuloma of vertebra L3, in a 15-year-old adolescent. Vertebral instability, due to aggravation of the osteolysis, occurred without neurological symptoms despite orthopedic treatment. Surgery was necessary to correct and stabilize the spinal deformation. Postoperative chemotherapy (vinblastine and corticoids) was given as recommended for Langerhans cell histiocytosis (HL2010). No recurrence was observed after 5 years of follow-up.
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Affiliation(s)
- K Bin
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion.
| | - S Jacopin
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion
| | - E Poinsot
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion
| | - C Stoven
- Service de pédiatrie, CHU Réunion, site Saint-Pierre, avenue François-Mitterrand, 97410 Saint-Pierre, Réunion
| | - J-C Ruzic
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion
| | - S Maurin
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion
| | - E Enaud
- Service de chirurgie pédiatrique, CHU Réunion, site Saint-Pierre, avenue Francois-Miterrand, 97410 Saint-Pierre, Réunion
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Lee SW, Kim H, Suh JK, Koh KN, Im HJ, Yoon HM, Seo JJ. Long-term clinical outcome of spinal Langerhans cell histiocytosis in children. Int J Hematol 2017; 106:441-449. [DOI: 10.1007/s12185-017-2252-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
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20
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Di Felice F, Zaina F, Donzelli S, Negrini S. Spontaneous and complete regeneration of a vertebra plana after surgical curettage of an eosinophilic granuloma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:225-228. [PMID: 28361364 DOI: 10.1007/s00586-017-5063-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE The eosinophilic granuloma is a unifocal or multifocal Langerhans cell histiocytosis characterized by an expanding proliferation of Langerhans cells in bones. Skeletal LCH is a rare condition, and vertebral regeneration in cases of vertebral body collapse is even rarer. We report the case of a girl with spontaneous complete healing. METHODS AD RESULTS A 3-year-old girl was referred for nighttime back pain, with no fever and no neurologic signs. Within a few days, she developed sudden painful restriction of all spine movements. X-ray and computed tomography (CT) of the spine showed reduced T7 vertebral body height (vertebra plana).The patient underwent T7 curettage and the histopathological exam was suggestive of LCH. Two additional skull lesions were found and therefore she underwent chemotherapy. After 7 years of follow-up, total vertebral reconstruction was observed. CONCLUSIONS Despite the rarity of the condition and despite the rarity of vertebral body lesion resolution, total vertebral body reconstruction was observed over a 7-year period. Long-term follow-up is necessary for a better understanding of the final outcome of patients with EG.
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Affiliation(s)
- Francesca Di Felice
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy.
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy
| | - Sabrina Donzelli
- ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, 20141, Milan, Italy
| | - Stefano Negrini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,IRCCS Fondazione Don Gnocchi, Milan, Italy
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21
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Erker C, Harker-Murray P, Talano JA. Usual and Unusual Manifestations of Familial Hemophagocytic Lymphohistiocytosis and Langerhans Cell Histiocytosis. Pediatr Clin North Am 2017; 64:91-109. [PMID: 27894453 DOI: 10.1016/j.pcl.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Familial hemophagocytic lymphohistiocytosis (FHL) and Langerhans cell histiocytosis (LCH) are histiocytic diseases that occur most commonly in young children. Improvements in recognition and treatment have been substantial for both diseases in the past decade, although early and late morbidity continue to be major concerns. These two diagnoses behave differently, although the clinical spectra for both diseases are diverse and can lead to confusion and delays in diagnosis and treatment. This article focuses on the clinical and genetic spectrum of FHL as well as the clinical and treatment variations of LCH.
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Affiliation(s)
- Craig Erker
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC 3018, Milwaukee, WI 53226, USA
| | - Paul Harker-Murray
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC 3018, Milwaukee, WI 53226, USA
| | - Julie-An Talano
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC 3018, Milwaukee, WI 53226, USA.
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22
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Angelini A, Mavrogenis AF, Rimondi E, Rossi G, Ruggieri P. Current concepts for the diagnosis and management of eosinophilic granuloma of bone. J Orthop Traumatol 2016; 18:83-90. [PMID: 27770337 PMCID: PMC5429252 DOI: 10.1007/s10195-016-0434-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
This review summarizes current concepts in the diagnosis and management of the patients with eosinophilic granuloma. Given the benign biology, the clinical course, and the pediatric group of patients that this condition more commonly affects, a treatment approach that carries a lower risk of complications while ensuring a successful cure is desirable. Variable treatment options have been reported with satisfactory results and a recurrence rate of less than 20 %. In this setting, symptomatic lesions that are accessible in the spine or the extremities may be treated with intralesional methylprednisolone injection after tissue biopsy for histological diagnosis.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Via Pupilli, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, Athens, Greece
| | - Eugenio Rimondi
- Department of Radiology and Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Rossi
- Department of Radiology and Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Ravindra VM, Eli IM, Schmidt MH, Brockmeyer DL. Primary osseous tumors of the pediatric spinal column: review of pathology and surgical decision making. Neurosurg Focus 2016; 41:E3. [DOI: 10.3171/2016.5.focus16155] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spinal column tumors are rare in children and young adults, accounting for only 1% of all spine and spinal cord tumors combined. They often present diagnostic and therapeutic challenges. In this article, the authors review the current management of primary osseous tumors of the pediatric spinal column and highlight diagnosis, management, and surgical decision making.
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Affiliation(s)
- Vijay M. Ravindra
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Ilyas M. Eli
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Meic H. Schmidt
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
| | - Douglas L. Brockmeyer
- 1Department of Neurosurgery, Clinical Neurosciences Center and Huntsman Cancer Institute, University of Utah; and
- 2Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah
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Sadashiva N, Rajalakshmi P, Mahadevan A, Vazhayil V, Rao KN, Somanna S. Surgical treatment of Langerhans cell histiocytosis of cervical spine: case report and review of literature. Childs Nerv Syst 2016; 32:1149-52. [PMID: 26753903 DOI: 10.1007/s00381-015-2989-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Langerhans cell histiocytosis (LCH) is a rare condition, and even rare is cervical spine involvement. CASE REPORT A 9-year-old girl had neck pain, neck tilt and left upper limb weakness, occasional fever and positive family history of tuberculosis. Imaging showed C5 vertebral body collapse with epidural and prevertebral soft tissue collection causing cord and nerve root compression. The patient underwent C5 corpectomy and fusion. Histopathological was suggestive of LCH. She underwent radiotherapy and was asymptomatic at 1-year follow-up. CONCLUSION Despite the rarity of the condition, the possibility of LCH should be considered in such cases. When neurologic deficits are present, operative treatment should be considered.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India
| | - P Rajalakshmi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India
| | - Kannepalli Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India.
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560 029, India
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Cañete AN, Bloem H, Kroon H. Tumores primarios de columna. RADIOLOGIA 2016; 58 Suppl 1:68-80. [DOI: 10.1016/j.rx.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/26/2022]
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Bumpass DB, Park A, Hill KT, Huang J, Friedman MV, Zebala LP. Eosinophilic granuloma of the sacrum treated with radiation therapy: a case report. Spine J 2016; 16:e53-7. [PMID: 26386170 DOI: 10.1016/j.spinee.2015.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Eosinophilic granulomas (EGs) of the sacrum have been reported in fewer than 10 patients. Treatment algorithms for these tumors remain poorly defined; there are no reports of treating solitary sacral EG with radiation therapy (RT). PURPOSE This study aimed to describe the presentation, treatment, and outcome of sacral EG in an adult patient with intractable pain and radiculopathy, treated in a novel fashion with RT. STUDY DESIGN/SETTING The study design was a case report from a tertiary cancer referral center. METHODS Patient records, imaging, and pathology were reviewed. RESULTS A 35-year-old man received 20 Gy of radiation to his S1 EG lesion. He subsequently developed vertebra plana of S1 causing symptomatic L5-S1 stenosis, but 15 months after RT treatment was free of pain or tumor recurrence. CONCLUSION Radiation therapy is an effective treatment option for sacral EG causing severe axial pain and neural impingement.
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Affiliation(s)
- David B Bumpass
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
| | - Andrew Park
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Kirk T Hill
- Department of Pathology, Washington University, 660 S. Euclid Ave, Campus Box 8118, St. Louis, MO 63110, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University, 660 S. Euclid Ave, Campus Box 8224, St. Louis, MO 63110, USA
| | - Michael V Friedman
- Mallinckrodt Institute of Radiology, Washington University, 660 S. Euclid Ave, Campus Box 8131, St. Louis, MO 63110, USA
| | - Lukas P Zebala
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
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Lam S, Reddy GD, Mayer R, Lin Y, Jea A. Eosinophilic granuloma/Langerhans cell histiocytosis: Pediatric neurosurgery update. Surg Neurol Int 2015; 6:S435-9. [PMID: 26539317 PMCID: PMC4604648 DOI: 10.4103/2152-7806.166761] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 01/21/2023] Open
Affiliation(s)
- Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Gaddum D Reddy
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Rory Mayer
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Yimo Lin
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Andrew Jea
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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Zheng W, Wu J, Wu Z, Xiao J. Atlantoaxial instability secondary to eosinophilic granuloma of the axis in adults: long-term follow-up in six cases. Spine J 2014; 14:2701-9. [PMID: 24647385 DOI: 10.1016/j.spinee.2014.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 02/11/2014] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Eosinophilic granuloma (EG) involving the spine is uncommon in adults. Atlantoaxial instability (AAI) secondary to EG of the axis in adults is an extremely rare clinical condition that can give rise to severe neurologic morbidity or mortality if not treated appropriately. There have been no previous reports on the condition in adults. PURPOSE To present the outcome and clinical experience for the management of AAI secondary to EG of the axis in adults. STUDY DESIGN A retrospective review study. PATIENT SAMPLE All adult patients with AAI secondary to EG of the axis who were admitted to the spine service at the study institution between January 1999 and April 2012. OUTCOME MEASURES Clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and/or complications were recorded and analyzed. METHODS Six consecutive adults who presented clinical and radiographic manifestations of AAI secondary to EG of axis were treated and monitored. All patients were treated surgically with anterior tumor resection and posterior reconstruction of spinal stability. Oral steroid therapy was administered after surgery as adjuvant therapy. RESULTS The mean duration of follow-up was 77 months (range, 37-140 months). The most common radiographic feature was osteolytic destruction of the vertebral body of the axis. All patients had favorable recoveries, with osseous fusion. There were no surgery-related postoperative complications, and neither recurrence nor spinal deformity had occurred by the final follow-up examination. CONCLUSIONS Surgical intervention via anterior tumor resection and posterior reconstruction was found to be safe and effective for treating AAI secondary to EG in adults, in terms of recovering neurologic function, improving symptom relief, and reducing the risks resulting from osteolytic destruction. Surgical treatment plus oral steroid therapy can produce beneficial results and definitive local control during the follow-up period.
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Affiliation(s)
- Wei Zheng
- Department of Orthopedics, ChengDu Military General Hospital, 270 Tianhui Rd, Rongdu Ave., ChengDu 610083, People's Republic of China
| | - Juan Wu
- Pharmacy Department, Research Center, ChengDu Military General Hospital, 270 Tianhui Rd, Rongdu Ave., ChengDu 610083, People's Republic of China
| | - ZhiPeng Wu
- Department of Orthopedics, Spine Tumor Center, ChangZheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, People's Republic of China
| | - JianRu Xiao
- Department of Orthopedics, Spine Tumor Center, ChangZheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, People's Republic of China.
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Lü GH, Li J, Wang XB, Wang B, Phan K. Surgical treatment based on pedicle screw instrumentation for thoracic or lumbar spinal Langerhans cell histiocytosis complicated with neurologic deficit in children. Spine J 2014; 14:768-76. [PMID: 24035731 DOI: 10.1016/j.spinee.2013.06.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/19/2013] [Accepted: 06/29/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical indications and procedures for spinal Langerhans cell histiocytosis (LCH) in children are still controversial. Reports containing large samples of surgically treated patients are few in the currently available literature, and the reported operative procedures were also somewhat obsolete. So, further investigation based on large-sample cases and using improved surgical techniques is beneficial and helpful to refine the treatment strategy. PURPOSE To recommend a reasonable treatment strategy for thoracic or lumbar spine LCH in children complicated with neurologic deficit. STUDY DESIGN/SETTING Retrospective/academic medical center. PATIENT SAMPLE Twelve children aged from 2 to 16 years old with the diagnosis of thoracic or lumbar spinal LCH accompanied by neurologic deficit received surgical treatment from January 2005 to January 2010. OUTCOME MEASURES Frankel scale for neurologic function, fusion of the mass, and recurrence of the lesion. METHODS All 12 patients presented initially with local pain and progressive neurologic detriment. Neurologic evaluation revealed two patients with Frankel Grade B, eight with Grade C, and two with Grade D. Radiographic features were positive for typical vertebra plana, a space-occupying mass in the spinal canal compressing neural elements, and a spinal canal encroachment rate more than 50%. Posterior instrumentation with pedicle screw combined with anterior corpectomy, decompression, and support bone graft was performed in the first seven patients as a one-stage procedure. In the remaining five patients, posterior pedicle screw fixation, laminectomy for decompression (via excision of the tumor-like mass), and repair of laminae with allograft bone block were performed. The collapsed vertebral body was left untouched. No chemotherapy or radiotherapy was administrated postoperatively in any of the cases. RESULTS The mean follow-up duration was 43.3 months. The mean operation time was 330 minutes with combined procedure and 142 minutes with single posterior approach (p=.000). The average blood loss was 933 mL with combined procedure and 497 mL with single posterior approach (p=.039). Three of seven patients who received combined surgery encountered approach-related complications, that is, one with intercostal neuralgia and two with pleural effusion. No severe neurologic deteriorate, instrumentation failure, or disease recurrence was detected at follow-up. Neurologic function completely recovered in all 12 patients from 2 to 12 weeks after surgery. The anterior bone graft fused and shaped well in all seven patients, and allograft bone block for lamina repair also achieved complete fusion in the remaining five patients. The internal fixator was removed at 3 to 5 years (average 4.1 years) after initial operation in six patients. No deformity, including scoliosis and kyphosis, has been identified during follow-up period in both procedures. CONCLUSIONS For spinal LCH patients, neurologic deficit is a main indication for operative treatment to prevent permanent and serious consequences. Surgery provides an opportunity for rapid recovery of neurologic function. Both combined and single-stage posterior approaches based on pedicle screw instrumentation techniques are similarly effective in relieving neurologic compression. However, single-stage posterior approach is more favorable with less complications, and preserving involved vertebral body is not a latent hazard of recurrence.
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Affiliation(s)
- Guo-Hua Lü
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China.
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan 410011, People's Republic of China
| | - Kevin Phan
- Department of Orthopaedic Surgery, University of California at Los Angeles, 1250 16th St, Suit 3145, Santa Monica, CA 90404, USA
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Abstract
Benign bone lesions are a broad category that demonstrates a spectrum of activities from latent to aggressive. Differentiating the various tumors is important in order to properly determine necessary intervention. This chapter focuses on the presentation, imaging, diagnostic features, and treatment of the most common benign bone tumors in order to help guide diagnosis and management.
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Affiliation(s)
- Robert Steffner
- Orthopaedic Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA,
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Bang WS, Kim KT, Cho DC, Sung JK. Primary eosinophilic granuloma of adult cervical spine presenting as a radiculomyelopathy. J Korean Neurosurg Soc 2013; 54:54-7. [PMID: 24044083 PMCID: PMC3772289 DOI: 10.3340/jkns.2013.54.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/06/2013] [Accepted: 07/17/2013] [Indexed: 11/27/2022] Open
Abstract
We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection.
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Affiliation(s)
- Woo-Seok Bang
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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Huang WD, Yang XH, Wu ZP, Huang Q, Xiao JR, Yang MS, Zhou ZH, Yan WJ, Song DW, Liu TL, Jia NY. Langerhans cell histiocytosis of spine: a comparative study of clinical, imaging features, and diagnosis in children, adolescents, and adults. Spine J 2013; 13:1108-17. [PMID: 23602327 DOI: 10.1016/j.spinee.2013.03.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 05/21/2012] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Langerhans cell histiocytosis (LCH) of the spine has been well documented in the literature, but most studies concern management of the disease. No focused report on the differences in clinical and radiographic features of spinal LCH among children, adolescents, and adults exists. PURPOSE To review and stress the clinical and imaging differences of spinal LCH in children, adolescents, and adults to avoid false diagnosis. STUDY DESIGN A retrospective study of children and adults with LCH of the spine. PATIENT SAMPLE Consecutive patients treated at our institution. OUTCOME MEASURES Visual analog scale for pain, Frankel scale for neurologic status, and X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) for imaging. METHODS Seventy-six patients with pathology-proven LCH involving the spine were treated at our institution between 1996 and 2010. Only patients with spine involvement pathologically and/or radiographically were included. Two groups were identified based on the age. Group I comprised children and adolescents (age <18 years; n=40) and Group II comprised adults (age ≥18 years; n=36). Analysis included age and gender distribution, clinical presentation, and imaging features and diagnosis. Pathologic diagnosis was performed by needle or open biopsy of the lesions. RESULTS Of the 76 patients, 55 were male and 21 were female (ratio of 2.62:1). Neck or back pain was the most common symptom in all patients and was the only presenting symptom in some patients. Restricted motion of spine was the most frequent symptom secondary to pain. Thirty-seven patients presented with neurologic symptoms. Adult patients were more likely to suffer neurologic deficits (p<.005). The distribution of lesions revealed predominance in the cervical spine, followed by thoracic and lumbosacral spine. Plain radiology of children and adolescents with spinal LCH usually revealed a typical vertebral plana, but the adult patients represented different severity of vertebral collapse without typical features. The images of CT scans between the two groups were similar, and all revealed lytic lesions in vertebral bodies and/or posterior elements. In Group I, lesions showed hypointense on T1-weighted images in 15 cases and isointense in 25 cases. Nineteen patients presented as intermediate to slight high signal on T2-weighted images, and the remaining patients presented as hyperintense on T2-weighted images. In Group II, lesions showed hypointense on T1-weighted images in 29 cases, isointense on T1-weighted images in seven cases, and hyperintense on T2-weighted images in 36 cases. Paraspinal soft tissue mass was detected in 28 and 23 cases in Group I and Group II, respectively. Fifteen children and adolescent patients versus 23 adult patients had epidural spinal cord compression. Oversleeve-like or dumbbell sign was observed in 21 cases in Group I but only in four cases in Group II. CONCLUSIONS The most common clinical manifestations of LCH of the spine were neck or back pain, followed by restricted motion of spine, neurologic symptoms, and deformity. Neurologic deficits were more frequent in adult patients. Vertebral plana is the typical imaging feature in children and adolescent patients but seldom in adults. Computed tomography is best for characterizing anatomy of the involved vertebra, and MRI is best for delineating marrow and soft tissue. The oversleeve-like sign on MRI may be a feature of spinal LCH as well as vertebra plana in children and adolescents. Needle biopsy under CT guidance should be performed before a treatment strategy is determined.
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Affiliation(s)
- Wending D Huang
- Department of Musculoskeletal Oncology Surgery, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China; Department of Orthopaedics, No. 411 Hospital of PLA, 15 Dongjiangwan Rd., Shanghai 200081, China
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Khung S, Budzik JF, Amzallag-Bellenger E, Lambilliote A, Soto Ares G, Cotten A, Boutry N. Skeletal involvement in Langerhans cell histiocytosis. Insights Imaging 2013; 4:569-79. [PMID: 23907805 PMCID: PMC3781243 DOI: 10.1007/s13244-013-0271-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/20/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) represents a disorder characterised by an abnormal accumulation of histiocytes in miscellaneous tissues. The bone is commonly affected, especially the flat bones, the spine and the long bones. Some lesions in children such as a “vertebra plana” or a solitary lytic lesion of the skull may be suggestive for LCH, whereas others can be confused with a malignant tumour or osteomyelitis. This pictorial essay presents the main usual and unusual skeletal manifestations observed in LCH. • Osseous involvement in children with LCH is very similar to that seen in multiple myeloma. • A solitary lytic lesion of the cranial vault is a typical radiographic finding of LCH. • A vertebra plana appearance in the spine is another typical radiographic finding. • Extensive signal intensity changes within bone marrow on MRI are a helpful sign for the diagnosis. • In long bones, endosteal scalloping may be responsible for a “budding appearance”.
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Affiliation(s)
- Suonita Khung
- Department of Pediatric Radiology, Hôpital Jeanne de Flandre, Université de Lille 2, CHRU de Lille, Lille, France
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Zhu C, Wang J, Zhang Y, Xia H, Yin Q. Basilar Invagination Caused by Langerhans Cell Histiocytosis of the Atlas in an Adult: A Case Report. JBJS Case Connect 2013; 3:e63. [PMID: 29252219 DOI: 10.2106/jbjs.cc.l.00255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- ChangRong Zhu
- Department of Orthopedics, Liu Hua Qiao Hospital, 111 Liu Hua Road, Guangzhou, 510010, China.
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Talamonti G, D'Aliberti GA, Debernardi A, Picano M. Paediatric spinal Langerhans cell histiocytosis requiring corpectomy and fusion at C7 and at Th8-Th9 levels. BMJ Case Rep 2012; 2012:bcr-2012-007660. [PMID: 23264157 DOI: 10.1136/bcr-2012-007660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 11-year-old girl was treated by corpectomy and anterior fusion because of the destruction of the C7 vertebral body. Pathological studies were not conclusive. The outcome was excellent, but 18 months later, she required thoracic corpectomy with anterior fusion owing to the impending kyphotic fracture of the Th8 vertebral body. Langerhans cell histiocytosis was now recognised and chemotherapy was given. 3 years later, the disease appears well controlled with normal shape of both the operated vertebral levels and maintenance of the movements of the adjacent vertebrae.
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Feng F, Tang H, Chen H, Jia P, Bao L, Li JJ. Percutaneous vertebroplasty for Langerhans cell histiocytosis of the lumbar spine in an adult: Case report and review of the literature. Exp Ther Med 2012; 5:128-132. [PMID: 23251253 PMCID: PMC3524240 DOI: 10.3892/etm.2012.791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/08/2012] [Indexed: 11/06/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is extremely rare in the lumbar spine of adults. The radiological features typically manifest as vertebral tumors. The exact etiology of LCH remains unknown. Langerhans cells may cause local or systemic effects. The most frequent sites of these bony lesions are the skull, femur, mandible, pelvis and spine. To date, only 3 spinal LCH cases treated by percutaneous vertebroplasty (PVP) have been reported. The present study reports a case of LCH of the fourth lumbar vertebra (L4) in a 51-year-old male with a 10-day history of low back pain, limited waist motion and right lower limb numbness. The patient was treated using PVP. The use of PVP for treating LCH of the spine was successful. The present study provides an up-to-date literature overview of LCH.
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Affiliation(s)
- Fei Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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Langerhans' cell histiocytosis in the pediatric spine: therapeutic dynamic change of spinal deformity. Childs Nerv Syst 2012; 28:1243-50. [PMID: 22543433 DOI: 10.1007/s00381-012-1764-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/10/2012] [Indexed: 12/25/2022]
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Abstract
The normal anatomy of the cervical spine and various imaging techniques for the evaluation of torticollis are reviewed, and possible causes of torticollis in infants and children are discussed, with an emphasis on relevant imaging findings. Torticollis is a congenital or acquired deformity characterized by rotational deformity of the cervical spine with secondary tilting of the head. Although torticollis is a sign of an underlying disease process, its presence does not imply a specific diagnosis, and the cause should be sought if torticollis persists or is associated with other symptoms. Congenital torticollis, seen in neonates and infants, usually results from craniocervical vertebral anomalies or muscular causes, although ocular abnormalities such as congenital paralytic squint (strabismus) and congenital nystagmus should also be considered. Acquired torticollis, seen in older children and adolescents, is often secondary to trauma, infection, or tumors. Imaging should be used as a general screening tool only after a complete medical history and clinical findings have been obtained. In newborns or infants with congenital torticollis, ultrasonography (US) is the modality of choice. In cases of acquired torticollis resulting from trauma, conventional radiography (lateral and anteroposterior views) should be the first-line imaging modality. In nontraumatic acquired torticollis, computed tomography (CT) of the neck or cervical spine is the initial imaging study. If CT findings are negative, magnetic resonance (MR) imaging of the brain and cervical spine should be performed. The use of multiple imaging modalities (conventional radiography, US, CT, and MR imaging) is common in the radiologic work-up of torticollis, and radiologists must understand the role of each imaging modality in patients of various ages.
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Affiliation(s)
- Saira Haque
- Department of Radiology, Manchester Academic Health Sciences Centre, Royal Manchester Children's Hospital, Oxford Rd, Manchester M13 9WL, England.
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Doléagbénou AK, Mukengeshay Ntalaja J, Derraz S, El Ouahabi A, El Khamlichi A. [Langerhans cell histiocytosis causing cervical myelopathy]. Neurochirurgie 2012; 58:263-7. [PMID: 22552159 DOI: 10.1016/j.neuchi.2012.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 01/03/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022]
Abstract
Langerhans cell histiocytosis (LCH), a disorder of the phagocytic system, is a rare condition. Moreover, spinal involvement causing myelopathy is even rare and unusual. Here, we report a case of atypical LCH causing myelopathy, which was subsequently treated by corporectomy and fusion. An 8-year-old boy presented with 3 weeks of severe neck pain and limited neck movement accompanying upper and lower limbs motor weakness. CT scans revealed destruction of C5 body and magnetic resonance imaging showed a tumoral process at C5 with cord compression. Interbody fusion using anterior cervical plate packed by autologus iliac bone was performed. Pathological examination confirmed the diagnosis of LCH. After the surgery, the boy recovered from radiating pain and motor weakness of limbs. Despite the rarity of the LCH in the cervical spine, it is necessary to maintain our awareness of this condition. When neurologic deficits are present, operative treatment should be considered.
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Affiliation(s)
- A K Doléagbénou
- Service de neurochirurgie, hôpital des spécialités Rabat, CHU Ibn-Sina, Rabat, Maroc.
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Abstract
STUDY DESIGN A case report and literature review. OBJECTIVE To illustrate the spontaneous resolution of unstable pathological fracture of the odontoid process of the C2 caused by Langerhans cell histiocytosis (LCH) in early childhood. SUMMARY OF BACKGROUND DATA The involvement of atlantoaxial LCH is very rare and its treatment is unfamiliar to surgeons. Therefore, the management of pediatric LCH of the odontoid process and the C2 body is challenging and must be adapted according to the patient's needs; it could range from observation to surgical intervention. METHODS A case of pathological fracture of the odontoid process with torticollis diagnosed with LCH of the odontoid process and C2 body and involving right femur in early childhood is presented. A histopathological study showed LCH. The patient underwent brace immobilization and systemic chemotherapy. RESULTS The patient showed successful bony remodeling without LCH recurrence on CT. The neck pain was resolved, and there was no limitation in neck movement. CONCLUSION Immobilization and systemic chemotherapy with close observation are adequate for the management of patients despite the unstable pathological fracture of the odontoid process.
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Tumours of the atlas and axis: a 37-year experience with diagnosis and management. Radiol Med 2011; 117:616-35. [PMID: 22095422 DOI: 10.1007/s11547-011-0753-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/18/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE This paper presents a single institution's longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options. MATERIALS AND METHODS We searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39.5 (range 5-77) years. For each patient, we collected data on clinical presentation, imaging and treatment. Mean follow-up was 10 years. RESULTS Benign bone tumours were diagnosed in 24 (39%) and malignant tumours in 38 (61%) patients. The most common tumours were bone metastases, followed by osteoid osteomas and chordomas. The atlas was involved in six and the axis in 52 patients; in four patients, both the atlas and axis were involved. The most common clinical presentation was pain, torticollis, dysphagia and neurological deficits. Surgical treatment was performed in 35 patients and conservative treatment, including intralesional methylprednisolone injections and halo-vest immobilisation with or without radiation therapy, chemotherapy or embolisation, in the remaining patients. One patient with osteoblastoma of the atlas had local recurrence. All patients with metastatic bone disease had local recurrence; four of the eight patients with plasmacytoma progressed to multiple myeloma within 1-4 years. All patients with chordomas had two to four local recurrences. Patients with osteosarcomas and chondrosarcoma died owing to local and distant disease progression. CONCLUSIONS Bone tumours of the cervical spine are rare. However, they should be kept in mind when examining patients with neck pain or neurological symptoms at the extremities. In most cases, only intralesional surgery can be administered. Combined radiation therapy and chemotherapy is indicated for certain tumour histologies.
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Montalti M, Amendola L. Solitary eosinophilic granuloma of the adult lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21 Suppl 4:S441-4. [PMID: 22042045 DOI: 10.1007/s00586-011-2052-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 09/05/2011] [Accepted: 10/15/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Eosinophilic granuloma (EG) is a benign bone tumor that rarely occurs in adults. It is usually found occurring in flat and long bones, but spine is often affected too. EG is of unknown aetiology, and the course of the disease is unpredictable. MATERIALS AND METHODS Two cases of EG of the adult lumbar spine are reported, representing a difficult challenge for diagnosis and treatment. CONCLUSION CT scan guided trocar biopsy allowed to achieve a definitive diagnosis, and CT scan guided intralesional infiltrations of corticosteroids were the successful treatment.
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Affiliation(s)
- Maurizio Montalti
- Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Via Pupilli 1, 40136, Bologna, Italy.
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CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine. Skeletal Radiol 2011; 40:757-64. [PMID: 20931189 DOI: 10.1007/s00256-010-1045-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/18/2010] [Accepted: 09/21/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the clinical and imaging outcome of patients with symptomatic eosinophilic granuloma of the spine treated with CT-guided intralesional methylprednisolone injection after biopsy. MATERIALS AND METHODS Patients (n =19) with symptomatic solitary eosinophilic granuloma of the spine treated by CT-guided intralesional methylprednisolone injection were retrospectively studied. There were 12 males and seven females with a mean age of 17 years (range, 3-43 years). The mean follow-up was 6 years (median, 4 years; range, 0.5-19 years). Spinal location included the cervical (two patients), thoracic (seven patients), lumbar spine (eight patients), and the sacrum (two patients). Vertebra plana was observed in two patients. All patients had biopsies before treatment. RESULTS Complete resolution of pain and healing of the lesion was observed in 17 patients (89.5%); none of these patients had recurrence at the latest examination. Reconstitution of the T1 and L1 vertebra plana was observed in both patients. Two patients initially diagnosed and treated for a solitary eosinophilic granuloma had constant pain after the procedure; in these patients, 6 and 12 months after the procedure, respectively, imaging showed multifocal disease and systemic therapy was administered. Complications related to the procedure were not observed. General anesthesia was administered in two patients because of intolerable pain during the procedure. CONCLUSIONS In view of the benign clinical course of eosinophilic granuloma, in patients with symptomatic lesions, CT-guided intralesional corticosteroid injection is a safe and effective outpatient treatment with a low complication rate.
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Mavrogenis AF, Rimondi E, Ussia G, Rossi G, Ruggieri P. Successful treatment of a bifocal eosinophilic granuloma of the spine with CT-guided corticosteroid injection. Orthopedics 2011; 34:230. [PMID: 21410115 DOI: 10.3928/01477447-20110124-29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Observation and immobilization is adequate for most patients with spinal eosinophilic granuloma; however, in patients with symptomatic lesions, treatment other than simple observation or biopsy alone is recommended. In view of the benign clinical course of eosinophilic granuloma, a simple, minimally invasive, outpatient treatment with a low complication rate such as computed tomography (CT)-guided intralesional corticosteroid injection may be considered the treatment of choice. This article presents a case of a 21-year-old man with a symptomatic bifocal eosinophilic granuloma at the vertebral body of the L3 vertebra and the left T5 costovertebral joint treated effectively by CT-guided intralesional methylprednisolone injection. To the best of our knowledge, this is the first case of successful treatment of a bifocal eosinophilic granuloma with CT-guided corticosteroid injection. Under general anesthesia and CT guidance, the lesion was located through the right transpedicular approach for the L3 lesion and the left posterolateral approach for the T5 lesion using a biopsy trocar. Tissue sample was retrieved and frozen section biopsy showed eosinophilic granuloma. One intralesional CT-guided injection of 80 mg (2 mL) of methylprednisolone acetate was performed in each lesion. Complications related to the procedure were not observed. The patient was admitted postprocedural for overnight medical evaluation and was discharged from the hospital the next day. Complete resolution of pain was observed 72 hours after the procedure. At 5 years after diagnosis and treatment, the patient is asymptomatic; imaging showed healing of both lesions.
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Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome. Acta Neurochir (Wien) 2010; 152:1129-37. [PMID: 20396916 DOI: 10.1007/s00701-010-0644-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 03/17/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND Eosinophilic granuloma (EG) of the spine is rare, especially in adults. There had been few large and long-term studies reported in the literature. The management goals of this disease in adults are preservation of neurologic function, relief of pain and reconstruction of spinal stability. However, there are still controversies over appropriate management modality of eosinophilic granuloma. METHODS Clinical manifestations, radiographic presentations, therapeutic outcomes and follow-up findings of 30 adults who were histiologically diagnosed with spinal eosinophilic granuloma, including 28 patients who received surgical treatment at our institutions from 1985 to 2008 were reviewed retrospectively. RESULTS There were 25 males and five females with a mean age of 34.5 years (range, 18-71 years). The post-operative follow-up period ranged from 2 to 22.4 years (mean, 8.3 years). Neurologic deficits developed in 21 patients, apparent kyphosis developed in four cases. In contrast to the classic feature of vertebra plana in children, we found that more severe lesions often led to asymmetric collapse in adult patients and only three patients presented with vertebra plana. Thirty-three vertebral lesions distributed throughout the spine column. Twenty-one lesions were in cervical spine, seven in the thoracic spine and five in the lumbar spine. Twenty-eight adult patients underwent surgical resection with or without chemotherapy or radiotherapy, and four (13.3%) patients had recurrence after surgery. No patient in our series died. CONCLUSIONS The onset of spinal EG is insidious and mainly presents as osteolytic destruction. There is a particular high prevalence of lesions in the cervical spine and more severe lesions often led to asymmetric collapse. As the skeleton of adults is well-developed and the epiphysis has stopped growing, individualized management including surgical intervention should be considered in adult patients with spinal EG who present with neurological damage and spinal instability.
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Langerhans cell histiocytosis with multiple spinal involvement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:1961-9. [PMID: 20496040 DOI: 10.1007/s00586-010-1390-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 10/31/2009] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
Abstract
To stress the clinical and radiologic presentation and treatment outcome of Langerhans cell histiocytosis (LCH) with multiple spinal involvements. A total of 42 cases with spinal LCH were reviewed in our hospital and 5 had multifocal spinal lesions. Multiple spinal LCH has been reported in 50 cases in the literature. All cases including ours were analyzed concerning age, sex, clinical and radiologic presentation, therapy and outcome. Of our five cases, three had neurological symptom, four soft tissue involvement and three had posterior arch extension. Compiling data from the eight largest case series of the spinal LCH reveals that 27.2% multiple vertebrae lesions. In these 55 cases, there were 26 female and 29 male with the mean age of 7.4 years (range 0.2-37). A total of 182 vertebrae were involved including 28.0% in the cervical spine, 47.8% in thoracic and 24.2% in the lumbar spine. Extraspinal LCH lesion was documented in 54.2% cases, visceral involvement in 31.1% and vertebra plana in 50% cases. Paravertebral and epidural extension were not documented in most cases. Pathological diagnosis was achieved in 47 cases including 8 open spine biopsy. The treatment strategy varied depending on different hospitals. One patient died, two had recurrence and the others had no evidence of the disease with an average of 7.2 years (range 1-21) of follow-up. Asymptomatic spinal lesions could be simply observed with or without bracing and chemotherapy is justified for multiple lesions. Surgical decompression should be reserved for the uncommon cases in which neurologic compromise does not respond to radiotherapy or progresses too rapidly for radiotherapy.
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El Asri AC, Akhaddar A, El Mostarchid B, Naama O, Sinaa M, Oukabli M, Al Bouzidi A, Gazzaz M, Boucetta M. Multiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report. Acta Neurochir (Wien) 2010; 152:703-6. [PMID: 19551334 DOI: 10.1007/s00701-009-0434-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 06/03/2009] [Indexed: 10/19/2022]
Abstract
Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. A surgically transpedicular biopsy of the thoracic collapsed vertebrae with posterior stabilization was made. Histological examination of the tissue showed features of eosinophilic granuloma. The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.
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Langerhans cell histiocytosis of the cervical spine: a single Chinese institution experience with thirty cases. Spine (Phila Pa 1976) 2010; 35:E8-15. [PMID: 20042947 DOI: 10.1097/brs.0b013e3181b8aa2d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A retrospective study of cervical Langerhans cell histiocytosis (LCH). OBJECTIVE To evaluate the safety and efficiency of the present diagnosis and treatment strategy. SUMMARY OF BACKGROUND DATA The diagnosis and treatment protocols are still controversial for the rarity of cervical LCH. METHODS Thirty patients with cervical LCH were diagnosed in the past 10 years. Biopsy was routinely performed to establish the final diagnosis before treatment. Immobilization was usually the first choice. Low-dose radiotherapy was suggested for cases with solitary marked bony erosion and/or soft tissue extension, and chemotherapy for cases with multiple lesions. Surgery was preserved for suspected malignancy, neurologic deficits, severe deformity, and/or instability. RESULTS The mean age at diagnosis was 14.2 (range: 1.5-41) years old. Neck pain (96.7%) was the most common symptom, followed by restricted motion (70%), neurologic symptoms (36.7%), and torticollis (30%). Four cases had multiple lesions. Fourteen cases had atlantoaxial lesion and 16 cases were subaxial. The lesion extended to paravertebral soft tissue in 40% cases, to epidural space in 30%, to pedicle and/or transverse process in 56.3%. One case had endplate destruction. The accuracy of percutaneous needle biopsy under CT guidance was 91.2%. Eighteen patients had conservative treatment and 12 underwent operation. Three cases involving C2 vertebral body had fixed atlantoaxial anterior dislocation. Another 3 cases with atlantoaxial lateral mass destruction had spontaneous fusion. Eighteen patients had conservative treatment (1 only by immobilization, 13 by radiotherapy, 2 by chemotherapy, and 2 by combined chemotherapy and radiotherapy) and 12 underwent operation. All the initial symptoms were resolved, and there was no recurrence. From retrospective view, the surgical procedure might be avoided in 60% cases. Twenty-five cases had an average 61.6-month follow-up. In cases with severe bony collapse, the vertebral height ratio increased from 20.0% to 44.9% and the lateral mass height ratio from 22.2% to 56.8%. CONCLUSION Cervical LCH lesions often extend to paravertebral soft tissue, epidural space, pedicles, and even to the endplate and lamina. Needle biopsy under CT guidance is safe and effective. The prognosis of cervical LCH is generally fair. Conservative treatment is usually enough and surgery should be reserved for major neurologic defects like myelopathy or monoparesis.
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Zhong WQ, Jiang L, Ma QJ, Liu ZJ, Liu XG, Wei F, Yuan HS, Dang GT. Langerhans cell histiocytosis of the atlas in an adult. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:19-22. [PMID: 19844749 DOI: 10.1007/s00586-009-1172-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Indexed: 11/30/2022]
Abstract
Langerhans cell histiocytosis (LCH), formerly known as histiocytosis X, is a rare disorder (approximately 1:1,500,000 inhabitants) characterized by clonal proliferation and excess accumulation of pathologic Langerhans cells causing local or systemic effects. The exact etiology of LCH is still unknown. LCH could affect patients of any age, although most present when they are children. The most frequent sites of the bony lesions are the skull, femur, mandible, pelvis and spine. A variety of treatment modalities has been reported, but there was no evidence suggesting that any one treatment was more advantageous than another. We present an adult with LCH of the atlas. A 26-year-old young man presented with a 2-month history of neck pain and stiffness. CT revealed osteolytic lesion in the left lateral mass of atlas with compression fracture. Histopathological diagnosis was Langerhans cell histiocytosis by percutaneous needle biopsy under CT guidance. The patient underwent conservative treatment, including Halo-vest immobilization and radiotherapy. At 7-year follow-up, the patient was asymptomatic except for mild motion restriction of the neck. CT revealed a significant reconstruction of the C1 lateral mass.
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Affiliation(s)
- Wo Quan Zhong
- Orthopaedic Department, Peking University Third Hospital, No 49, North Garden Street, HaiDian District, 100191, Beijing, China.
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