Ueda Yasuhiro, Murakami Hideki, Demura Satoru, Kawahara Norio, Tomita Katsuro, Tsuchiya Hiroyuki
Department of Orthopedic Surgery, Fukui Prefectural Hospital, 2-8-1, Yotsui, Fukui 9108526, Japan.
Orthopedics. 2012 Dec;35(12):e1818-21. doi: 10.3928/01477447-20121120-32.
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.
脊柱嗜酸性肉芽肿是儿童和青少年常见的良性疾病，很少累及成人。本文描述了一名32岁女性的病例，其孤立性嗜酸性肉芽肿表现为L4椎体的局部溶骨性病变。她有2个月的腰痛病史，无神经功能缺损。X线平片显示L4椎体溶骨性病变。计算机断层扫描显示L4椎体溶骨性病变周围有部分硬化改变。磁共振成像显示T1加权像上为低信号病变，T2加权像上为高信号病变。对L4椎体进行了计算机断层扫描引导下的经椎弓根针吸活检。苏木精-伊红染色的组织学标本显示嗜酸性肉芽肿的特征，伴有朗格汉斯细胞聚集。免疫研究中，S-100蛋白和CD1a的弥漫性免疫反应有助于嗜酸性肉芽肿的诊断。活检后的3个月内，患者佩戴了束腰，并允许行走。活检后4个月，计算机断层扫描显示L4椎体破坏性病变正在重塑。发病两年后，患者腰痛完全缓解，无神经功能缺损。计算机断层扫描显示病变完全修复。这是一例成人腰椎嗜酸性肉芽肿成功保守治疗的罕见病例。对于无神经功能缺损或脊柱不稳定的嗜酸性肉芽肿患者，可考虑保守治疗。
