J Korean Neurosurg Soc.  2013 Jul;54(1):54-57. 10.3340/jkns.2013.54.1.54.

Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy

• Bang WS
• Kim KT
• Cho DC
• Sung JK

• KMID: 2190860
• DOI: http://doi.org/10.3340/jkns.2013.54.1.54

Abstract

We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection.

Keyword

Eosinophilic granuloma; Adult cervical tumor; Surgical approach

MeSH Terms

Adult
Arm
Eosinophilic Granuloma
Follow-Up Studies
Hand Strength
Humans
Magnetic Resonance Imaging
Paresthesia
Spine
Transplants

Figure

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  Fig. 1 Preoperative radiographic images show tumorous condition. MRI showed collapse of C7 vertebral body and extension to paravertebral soft tissue and epidural space without invasion to adjacent disc spaces. In addition, epidural extension produced cord compression without definite cord signal change. Computed tomography scan and simple radiograph revealed severe bony destruction and sparing of the posterior column. A : T1 weighted sagittal MRI scan. B : T2 weighted sagittal MRI scan. C : T1-weighted gadolinium-enhanced axial MRI scan. D : Simple lateral radiographs at presentation. E : Coronal CT scan. F : Axial CT scan.

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  Fig. 2 POD 1 radiographic images show C7 corpectomy state. A : Simple lateral radiograph. B : Cervical sagittal CT scan. C : Cervical coronal CT scan.

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  Fig. 3 Twelve month follow up MRI demonstrate no evidence of recurrence. A : T2 weight sagittal MRI scan. B : T1 weight sagittal MRI scan.

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  Fig. 4 Histopathological examination of the patient. A : On hematoxylin-eosin staining (magnification ×400), the section consists of many cells showing that Langerhans cell features have convoluted nuclei and linear grooves. This lesion was associated with numerous giant cells and eosinophils. B and C : Immunostains for S100 (Magnification ×400) (B) and CD1a (magnification ×400) (C) show diffuse strong cytoplasmic staining on the Largerhans cells.

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