Eosinophilic granuloma of the mandible: a diagnostic dilemma

Abstract

Eosinophilic granuloma (EG) is a rare histiocytic disorder resulting from clonal proliferation of Langerhans cells. It accounts for less than 1% of all osseous neoplasms and has a predilection for involving the axial skeleton. Although suspicion of the disease may arise from clinical features and radiographic demonstration of destructive bone lesions, it is still difficult to make a correct diagnosis without proper pathological evaluation. This is more evident when common differentials mimicking EG, both clinically and radiologically, need to be ruled out. This report describes a case of unifocal EG of the mandible occurring in a 4-year-old boy whose initial presentation led to confusion between osteomyelitis, primary bone tumour and lymphoma. A final diagnosis of EG was established after histopathological examination of the biopsy specimen.

Eosinophilic Granuloma of the Mandible

“…In the literature medical treatments are suggested such as chemotherapeutic treatment, using intralesion injection of corticosteroids or vinblastine 3 and radiation therapy, 8,9 but the patient did not want a continuous therapy. In the literature medical treatments are suggested such as chemotherapeutic treatment, using intralesion injection of corticosteroids or vinblastine 3 and radiation therapy, 8,9 but the patient did not want a continuous therapy.…”

Diagnosis and management of eosinophilic granuloma of the jaw: a case report

“…It is a bone lesion that may present in a solitary or multiple forms. Approximately 50% of cases develop in the first two decades of life and between 10 and 20% occur in the mandibular bone [2][3][4][5][6].…”

“…The most frequent signs and symptoms of this pathology are pain, edema, ulceration, gingival necrosis, destruction of the alveolar bone with mobility and loss of teeth [3,6,7]. Depending on the bone destruction of the maxillae, it may lead to pathological fractures [3,7].…”

“…Radiographically, the lesions present as radiolucent areas accompanied by a perforating aspect without cortical margin, and become more evident when the alveolar cortical bone is destroyed. Extensive involvement of the alveolar bone may result in the appearance of teeth "floating in the air" [1,6,8]. In these cases teeth may be observed with the presence of mobility and deep periodontal pockets, mucosa with ulcerative or proliferative lesions, with erythema and severe tendency to bleeding on probing [7].…”

“…The therapeutic options for the treatment of EG are surgical removal by means of curettage, radiotherapy in low doses, chemotherapy, intralesional injection of steroids for reduction in size of the lesion followed by curettage, and depending on the case, there are reports of spontaneous resolution of the lesion [3,7,8]. Moreover, for confirmation of the diagnosis, incisional biopsy and histopathological analysis [6] are necessary, because from the clinical characteristics of the lesion, it may present differential diagnosis from other pathologies, such as osteomyelitis, carcinoma, sarcoma, lymphoma, Paget's disease, multiple myeloma and Papillon-Lefèvre Syndrome [3,6,8].…”