Eosinophilic Granuloma

Ramin Khorasani, MD
Madeleine D Kraus, MD
Piran Aliabadi, MD

March 16, 1994

Presentation

Imaging Findings

CT shows 1 cm destructive lesion of the left frontal bone (arrows) with more involvement of the outer table compared to the inner table. There is accompanying asymmetric soft tissue swelling.

Bone scintigraphy shows a focus of increased tracer uptake (arrow) orresponding to CT abnormality. No other abnormal focus of tracer uptake is identified.

Differential Diagnosis

Diagnosis

Discussion

Eosinophilic granuloma occurs most frequently in children and is rare beyond the age of 20. Solitary painful bone lesions are the most ommon presentation, although they may be disseminated and polyostotic. Eosinophilic granuloma is one of the diseases that may have an associated sequestrum. The skull is usually involved, but lesions may be seen in any bone. Prognosis is excellent.

Pathology

Eosinophilic granuloma, which is classified with tumors of histiocytic origin, may be an isolated bony lesion or parenchymal (usually located in the cranium), or may be part of systemic disease (e.g. Letterer- Siwe disease or Hand-Schuller-Christian disease). Grossly, the tumor usually has ill-defined borders and a yellow-tan appearance. Microscopically, it is composed of large multinucleated giant cells with a polymorphous, eosinophil-rich inflammatory infiltrate. The differential diagnosis includes osteomyelitis, non-Hodgkin's lymphoma, and Hodgkin's disease. Special studies, including electron microscopy, may be necessary to resolve this differential.

References

2. Malone. The histiocytoses of childhood. Histopath 1991;19(2): 105-119.

3. Ben-Ezra. Langerhans cell histiocytoses and malignancies of the M-PIRE system. Am J Clin Path 1993;99(4):464-71.

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