Imaging Sci Dent.  2013 Jun;43(2):117-122. 10.5624/isd.2013.43.2.117.

Eosinophilic granuloma in the anterior mandible mimicking radicular cyst

• Lee BD
• Lee W
• Lee J
• Son HJ

• KMID: 1974439
• DOI: http://doi.org/10.5624/isd.2013.43.2.117

Abstract

Eosinophilic granuloma is a common expression of Langerhans cell histiocytosis and corresponds with typical bone lesions. The radiographic appearance of eosinophilic granuloma in the jaw is variable and not specific. It may resemble periodontitis, radicular cyst, or malignancies. The purpose of this report is to describe the characteristic radiographic features of eosinophilic granuloma of a 39-year-old male. The lesion in the anterior mandible was first diagnosed as radicular cyst because the radiographic findings were ovoid radiolucent lesion with well-defined border. However, careful interpretation revealed a non-corticated border and floating tooth appearance that were the characteristic radiographic features for the differential diagnosis. Early clinical signs of eosinophilic granuloma can occur in the jaw and a bony destructive lesion might be mistaken for periodontitis or an odontogenic cystic lesion; therefore, careful interpretation of radiographs should be emphasized.

Keyword

Eosinophilic Granuloma; Histiocytosis, Langerhans-Cell; Mandible; Radicular Cyst

MeSH Terms

Diagnosis, Differential
Eosinophilic Granuloma
Eosinophils
Histiocytosis, Langerhans-Cell
Humans
Jaw
Male
Mandible
Odontogenic Cysts
Periodontitis
Radicular Cyst
Tooth

Figure

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  Fig. 1 A. A panoramic radiograph shows a radiolucent lesion with a well-defined margin from the left lower lateral incisor to the right lower canine. B. A periapical radiograph reveals a radiolucent lesion with a non-corticated border and beveled edges. The distal part of the right lower lateral incisor shows a "floating tooth" appearance.

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  Fig. 2 A periapical radiograph shows root canal treatment of the mandibular left central incisor and right canine.

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  Fig. 3 An axial CT image shows a focal bony destructive lesion in the anterior mandible. Destruction of the buccal and lingual cortex is also observed.

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  Fig. 4 Fat saturated coronal T2 weighted MR image (TR/TE: 3750/103 milliseconds) shows a focal high signal lesion (arrow) in the left femur tronchanter with adjacent bone marrow edema.

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  Fig. 5 Bone scintigraphy. A. The initial study shows normal uptake of the radiotracer in the trochanteric portion of the left femur. B. The one year follow-up study demonstrates an uptake lesion in the left femur.

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  Fig. 6 Panoramic radiograph (2 years later) shows a slight increase in the lesion size in the anterior part of the mandible compared with the initial radiographs.

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  Fig. 7 A. Numerous Langerhans cells, recognized by their grooved, folded, or indented nuclei with fine chromatin, inconspicuous nucleoli, and thin nuclear membranes, with a few scattered eosinophils and small lymphocytes are seen (H&E stain, 400×). The tumor cells are strongly immunoreactive for S-100 protein (B, 200×) and CD1a (C, 200×) in the cytoplasm.

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