[Eosinophilic granuloma of the cervical spine with atypical neurological, cerebrospinal fluid and radiological manifestations]

[Eosinophilic granuloma of the cervical spine: case report]

Eosinophilic granuloma (EG) is a benign condition of histocytes proliferation localized or multifocal. It is presents in the cervical spine in 1.5%-20% of the cases of EG. We report the case of a seven-year-old girl that presented with a one month history of cervical pain, persistent wryneck and vicious posture of the neck. A computerized tomography was performed and confirmed the presence of spreading lesion, ostheodestructive to the level of the left laminae of C2, with invasion of the spine and the muscular tissue. A laminectomy was underwent for removal of the lesion. The patient had a good post-operative recovery with improvement of the symptoms. Chemotherapy with prednisone, vinblastine and ethoposide was administred. After six months, this protocol was repeated associaded to methotrexate. The patient improved and had no new symptoms in a follow-up of 36 months.

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.

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.

Spinal cord compression by eosinophilic granuloma of the cervical spine. Case report and review of the literature

Eosinophilic granuloma is an uncommon lesion, often self-limiting. A location in the spine is rare; until now, only 35 cases have been reported. MRI is the most effective diagnostic technique, although conventional X-ray can also be useful as a first approach. Therapy consists of immobilization of the patients, surgery and chemotherapy as required by to the clinical findings of the lesion. The role of radiotherapy is still controversial. The authors describe the fourth case of eosinophilic granuloma of the cervical spine with neurological symptoms reported in literature.

Eosinophilic granuloma of the cervical spine. A case report and review of the literature

This is a report of a case of eosinophilic granuloma involving the second cervical vertebra in a 33-year-old woman. There have been 32 case reports in the literature describing eosinophilic granuloma presenting as cervical spine disease. Due to its intimate relation to the central nervous system, the opportunity for neurological sequelae and neurosurgical intervention is common in cervical eosinophilic granuloma. In this report a brief history of eosinophilic granuloma is reviewed and case histories from the literature with cervical spine involvement are summarized. The therapeutic options are described and a recommended protocol for management is outlined.