Korean J Neurotrauma.  2015 Apr;11(1):22-25. 10.13004/kjnt.2015.11.1.22.

Rapid Growing Eosinophilic Granuloma in Skull after Minor Trauma

• Kim YJ
• Jo KW

• KMID: 2156088
• DOI: http://doi.org/10.13004/kjnt.2015.11.1.22

Abstract

The authors present a case of rapidly progressing eosinophilic granuloma (EG) of the skull without hemorrhage after minor trauma. A 6-year-old boy presented with a soft mass on the midline of his forehead. He had a surgery for EG 19 months ago. One month earlier, computed tomography (CT) and bone scans were performed to evaluate the possible recurrence of EG, and there was no evidence of recurrence in CT. However, a slightly increased uptake in the bone scan was noted on the midline of the forehead. A rapid growing mass developed in a new spot after a minor trauma 7 days before the patient arrived at the clinic. His physical examination was unremarkable, except for a non-tender, soft, and immobile mass. A plain skull X-ray and CT showed a lytic bony defect on the midline of the frontal bone. Magnetic resonance imaging showed a 1.4 cm sized enhancing mass. Surgical resection and cranioplasty were done. The role of trauma in the development of EG is unclear. However, our case suggests that minor trauma is an aggravating factor for EG formation. Careful observation with regular follow-up is necessary in patients with EG after minor trauma.

Keyword

Eosinophilic granuloma; Craniocerebral trauma; Child; Rapid progression

MeSH Terms

Child
Craniocerebral Trauma
Eosinophilic Granuloma*
Forehead
Frontal Bone
Hemorrhage
Humans
Magnetic Resonance Imaging
Male
Physical Examination
Recurrence
Skull*

Figure

• 

  FIGURE 1 T1 enhanced images (A: coronal, B: sagittal) showing a 2.3 cm-sized enhancing mass in the mid vertex 19 months ago.

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  FIGURE 2 A: Skull lateral image taken one month prior to trauma showed no evidence of recurrence. B: Non-contrast axial computed tomography image.

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  FIGURE 3 A, B: Three-dimensional computed tomography showing lytic bony defect in the frontal region (small arrow: previous operation lesion, large arrow: new developed lesion). C, D: Sagital magnetic resonance imaging showing a 1.4 cm-sized enhnacing mass (C: non-contrast, D: contrast).

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  FIGURE 4 A: After the scalp flap was reflected, a protruding mass was found. (B) The mass was completely removed, and (C) a cranioplasty was performed with bone cement.

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  FIGURE 5 A, B: There are numerous oval Langerhans cells with many nuclei containing linear grooves (H-E, ×100). Eosinophilic microabscesses are noted (H-E, ×400). C: The surfaces of the Langerhans cells are uniformly positive for CD1a staining (×400). D: Strong positive staining is both nuclear and cytoplasmic with S-100 (×400).

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  FIGURE 6 Computed tomography six months after the operation showing no recurrence. A: Axial noncontrast image. B: Sagittal contrast image.

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