Ando Akiro, Hatori Masahito, Hosaka Masami, Hagiwara Yoshihiro, Kita Atsushi, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan 980-8574.
Ups J Med Sci. 2008;113(2):209-16. doi: 10.3109/2000-1967-230.
Eosinophilic granuloma (EG) is a benign tumor-like condition which is characterized by a clonal proliferation of Langerhans-type histiocytes and defined as a local form of Langerhans cell histiocytosis (LCH). The radiographic appearances of EG are quite different depending on the phase of the disease and the site of involvement. A status of EG in the bone is divided into acute and chronic phases. Radiologically acute phase of EG is difficult to differentiate from a malignant bone tumor such as Ewing's sarcoma or acute osteomyelitis. Chronic phase of EG may mimic a chronic osteomyelitis or a benign bone tumor. We report 3 children's cases of EG in the pelvis which showed quite different radiological features and clinical courses. A 6-year-old boy (Case 1) had an osteolytic lesion with slightly defined margins in the right acetabulum. A 4-year-old boy (Case 2) had a radiologically similar-looking lesion in the left acetabulum. These lesions resembled radiologically chronic osteomyelitis (Brodie's abscess) or a benign bone tumor and healed spontaneously after biopsy. A 2-year-old boy (Case 3) had an osteolytic lesion with ill-defined margin in the ilium. It was difficult to differentiate from a malignant tumor such as Ewing's sarcoma, or acute osteomyelitis. The lesion became enlarged after needle biopsy. In spite of an additional curettage, the osteolytic lesion remained in the left pelvis in 1 year. Treatment for EG is controversial. Curettage of the affected site and bone grafting is usually accomplished. However, some EG heal spontaneously. It is of great importance to understand the natural course of EG and this knowledge will give us the opportunity to avoid unnecessary treatment. EG with poor osteolytic margins may progress further after biopsy. EG with well-defined margins may heal spontaneously after biopsy only.
嗜酸性肉芽肿（EG）是一种良性肿瘤样病变，其特征为朗格汉斯细胞型组织细胞的克隆性增殖，被定义为朗格汉斯细胞组织细胞增多症（LCH）的一种局部形式。EG的影像学表现因疾病阶段和受累部位而异。骨内EG的状态分为急性期和慢性期。放射学上，EG的急性期难以与恶性骨肿瘤如尤因肉瘤或急性骨髓炎相鉴别。EG的慢性期可能类似慢性骨髓炎或良性骨肿瘤。我们报告3例儿童骨盆EG病例，其显示出截然不同的放射学特征和临床病程。一名6岁男孩（病例1）右侧髋臼有一个边缘略模糊的溶骨性病变。一名4岁男孩（病例2）左侧髋臼有一个放射学表现相似的病变。这些病变在放射学上类似慢性骨髓炎（布罗迪脓肿）或良性骨肿瘤，活检后自发愈合。一名2岁男孩（病例3）髂骨有一个边缘不清的溶骨性病变。难以与尤因肉瘤等恶性肿瘤或急性骨髓炎相鉴别。针吸活检后病变增大。尽管进行了额外的刮除术，但1年后左侧骨盆仍有溶骨性病变。EG的治疗存在争议。通常会对受累部位进行刮除和植骨。然而，一些EG会自发愈合。了解EG的自然病程非常重要，这将使我们有机会避免不必要的治疗。边缘溶骨情况差的EG在活检后可能会进一步进展。边缘清晰的EG可能仅在活检后自发愈合。
