CASE 1062 Published on 06.05.2001

Eosinophilic granuloma of the calvarium

Section

Neuroradiology

Case Type

Clinical Cases

Authors

S. Cakirer (1), M. Beser (2), K. Demir (3)

Patient

3 years, female

Categories
No Area of Interest ; Imaging Technique MR, MR
Clinical History
A 3-year-old female patient presented with a tender soft tissue swelling at the left parietal region and headache, and a solitary lytic lesion on her skull X-ray film.
Imaging Findings
A 3-year-old female patient presented with a tender soft tissue swelling at the left parietal region and left sided headache. A solitary lytic lesion was detected on her skull X-ray film. MRI study of the cranium on three planes with SE T1, FSE T2, post-gadolinium T1 sequences was performed, demonstrating a left parietal calvarial mass with slightly low intensity on T1- , high intensity on T2-weighted images, and with intense contrast enhancement. The mass was surgically removed with histopathological confirmation.
Discussion
Eosinophilic granuloma (EG) is a localized form of histiocytosis X, or Langerhans' cell histiocytosis, a benign lesion of proliferating Langerhans' cells. It is the least severe of the histiocytosis syndromes, and is characterized by lytic lesions of one or more bones. Histopathologically there is influx of eosinophilic leukocytes simulating inflammation, reticulum cells accumulate cholesterol and lipids, so called foam cells, nodules of histiocytes may fuse to form giant cells and their cytoplasms contain Langerhans bodies. The bone lesions arise within the medullary canal. EG is most frequently seen in patients within the range of 5-10 year-old. The calvarium is most frequent location for EG, especially diploic space of the parietal bone and petrous ridge of the temporal bone. The lesions are sharply circumscribed soft tissue masses with epidural and subgaleal components, they have heterogeneous hypointense signal intensity on T1-, and heterogenenous hyperintense signal intensity on T2-weighted sequences, and intense contrast enhancement following IV gadolinium injection. They cause round or ovoid punched-out lesions with serrated and beveled edges. On roentgenograms due to uneven involvement of inner and outer tables of calvarium a hole-within-hole appearance is characteristic. The soft tissue mass overlying the lytic process in calvarium is often palpable. The lesions of EG are generally soft, and can easily be removed surgically.
Differential Diagnosis List
Eosinophilic granuloma of the calvarium
Final Diagnosis
Eosinophilic granuloma of the calvarium
Case information
URL: https://eurorad.org/case/1062
DOI: 10.1594/EURORAD/CASE.1062
ISSN: 1563-4086