Spinal cord compression by a unifocal eosinophilic granuloma: a case report of an adult with unusual roentgenological features

Eosinophilic granuloma of the lumbar spine in an adult

Eosinophilic granuloma of the spine is a common benign disease in children and adolescents that rarely affects adults.This article describes the case of a 32-year-old woman with a solitary eosinophilic granuloma presenting as a local lytic lesion at the L4 vertebral body. She presented with a 2-month history of low back pain without neurological deficits. Plain radiographs showed a lytic lesion of the L4 vertebral body. Computed tomography scans showed an osteolytic lesion surrounded by partial sclerotic change of the L4 vertebral body. Magnetic resonance imaging revealed a low-intensity lesion on T1-weighted images and a high-intensity lesion on T2-weighted images. A computed tomography-guided transpedicular needle biopsy of the L4 vertebral body was performed. The histological specimen stained with hematoxylin-eosin revealed features of eosinophilic granuloma with aggregates of Langerhans cells. On immunological studies, the diagnosis of eosinophilic granuloma was facilitated by diffuse immunoreactivity of S-100 protein and CD1a. For the 3-month period after biopsy, the patient was fitted with a corset and allowed to walk. Four months after biopsy, computed tomography scans showed that remodeling of the destructive lesion of the L4 vertebral body was occurring. Two years after initial onset, the patient had complete relief of low back pain and no neurologic deficit. Computed tomography scans showed full reconstitution of the lesion. This was a rare case of successful conservative treatment of eosinophilic granuloma of the lumbar spine in an adult. Conservative treatment may be considered in a patient with an eosinophilic granuloma with no neurological deficit or spinal instability.

Eosinophilic granuloma of the cervical spine

STUDY DESIGN

A meta-analysis was performed based on 53 cases of cervical eosinophilic granuloma reported in the literature and 1 in an adult treated by the authors.

OBJECTIVE

To stress the clinical and radiologic differences between cervical and thoracolumbar spinal eosinophilic granuloma and to point out differences between adults and children with cervical eosinophilic granuloma to avoid false diagnosis.

SUMMARY OF BACKGROUND DATA

Until now, cervical eosinophilic granuloma has been reported in 43 children and 9 adults. In 1 case the age is unknown. In previous studies, differences between adults and children with cervical eosinophilic granuloma have not been analyzed, nor has cervical eosinophilic granuloma been compared with thoracolumbar eosinophilic granuloma.

METHODS

All reported cases of cervical eosinophilic granuloma were analyzed concerning age and sex distribution, clinical and radiologic presentation, therapy, and outcome. The authors' case in a 46-year-old patient is discussed.

RESULTS

The presenting symptoms of cervical eosinophilic granuloma are usually pain and restricted range of motion. In contrast to eosinophilic granuloma of the thoracic spine and lumbar spine, the neurologic symptoms are less frequent, and the first radiographic sign is an osteolytic lesion. Vertebra plana is a rare sign in cervical eosinophilic granuloma. In children, the middle cervical spine is most often affected, whereas in adults it is the second vertebra. The outcome of the patients has been good in most cases, independently of treatment.

CONCLUSION

In most cases of cervical eosinophilic granuloma, immobilization is an adequate therapy. If the process continuous to progress, radiotherapy is recommended. Surgical treatment should be reserved for cases with instability or neurologic defects.

Anterior cervical corpectomy and fusion using miniplate and screws in a 7-year-old child with eosinophilic granuloma of the cervical spine

STUDY DESIGN

This is a case report of a 7-year-old child with eosinophilic granuloma in the cervical spine, which underwent anterior cervical corpectomy and fusion by using Miniplate and screws.

OBJECTIVES

To describe the use of Miniplate and screws for pediatric cervical anterior fusion.

SUMMARY OF BACKGROUND DATA

Eosinophilic granuloma is a rare disease causing destructive bony lesions of the cervical spine in children. A complete resection and fusion were considered to be the preferable treatment in our case. However, cervical spinal fusion and instrumentation in children may be technically difficult because of the size of the vertebral body and the iliac bone. In addition, a proper device for an internal fixation in pediatric patients is not yet available.

METHODS

A case of eosinophilic granuloma in pediatric spine was presented.

RESULTS

We confirmed successful bony fusion and the restoration of the normal cervical curvature without recurrence of the tumor 2 years after the procedure.

CONCLUSIONS

For proper internal fixation and prevention of dislodgement of the grafted bone, we used the Miniplate and screws as internal fixator after intralesional resection of the tumor mass.

Cervical spine cord compression by eosinophilic granuloma. Case report

Eosinophilic granuloma is a term reserved for the most often and benign form of disorder known as Langerhans cells histiocytosis. It is a disease of children and adolescents that very rarely affects adults, representing the localized form of a pathological proliferation of histiocytes in bones, like skull and long bones. Vertebral involvement is uncommon, approximately 8% of the cases, being the cervical localization the least affected. Moreover, the involvement of the spinal cord and roots remains a rare occurrence. Only five cases characterized by signs of cervical spinal cord compression have been reported. We report the sixth case in a 42-year-old-man who evolved with resolution of symptoms, and has remained asymptomatic after treatment. The clinical, radiological and histological features and, also, the value, in selected cases, of surgical treatment followed by low-dose radiation therapy is discussed. A review of the pertinent literature is also presented.

Langerhans' cell histiocytosis and the nervous system

We report two cases of Langerhans' cell histiocytosis with unusual central nervous system (CNS) involvement. The first patient had behavioural disturbances, memory loss and diabetes insipidus. His response to a range of treatments was poor. The second patient presented with seizures and headaches suggestive of raised intracranial pressure. Etoposide (VP16) chemotherapy led to a dramatic clinical and radiological improvement. The various CNS manifestations of Langerhans' cell histiocytosis and their management are discussed.