Paradigm shift in vertebral eosinophilic granuloma




eosinophilic granuloma, spine, treatment


Objective: Eosinophilic granuloma is the most common type of Langerhans cell histiocytosis. Vertebral bone involvement of eosinophilic granuloma is a rare disease. There are few studies in the literature on patients with vertebral bone involvement diagnosed with eosinophilic granuloma. There is still no clear protocol for the treatment of patients with vertebral involvement with eosinophilic granuloma. This article is a summary of the clinical follow-ups of our 6 cases diagnosed with spinal eosinophilic granuloma. We changed the chemotherapy protocol or extended the duration of chemotherapy in patients with progressive disease.
Methods: In this study, there are six patients (4 male and 2 female) with vertebral involvement of eosinophilic granuloma in our hospital between September 2017 and August 2022. The clinical findings, radiological images, treatments and follow-up results of the patients were analyzed retrospectively.
Results: In the follow-ups, a new vertebral bone involvement was observed in two patients and a femoral bone involvement was observed in another patient. One patient with neurological deficit underwent surgical treatment. Chemotherapy treatment was given to four patients with multiple bone involvement or recurrence. No recurrence was observed in three patients who started chemotherapy treatment after recurrence.
Conclusions: Surgical treatment should be considered in patients with neurological deficits and spinal instability. According to the results of our study, patients with multiple bone or systemic involvement and no neurological deficit should receive chemotherapy treatment. We recommend changing the chemotherapy protocol or extending the chemotherapy duration in patients with progressive disease.

Author Biographies

Muhammet Arif Ozbek, Istanbul Medipol University, Istanbul

Department of Neurosurgery

Veyselkarani Ipek, Istanbul Medipol University, Istanbul

Department of Neurosurgery

Cem Dinс, Istanbul Medipol University, Istanbul

Department of Neurosurgery


1. Lıchtensteın L. Histiocytosis X; integration of eosinophilic granuloma of bone, Letterer-Siwe disease, and Schüller-Christian disease as related manifestations of a single nosologic entity. AMA Arch Pathol. 1953 Jul;56(1):84-102. [PubMed]

2. Brown CW, Jarvis JG, Letts M, Carpenter B. Treatment and outcome of vertebral Langerhans cell histiocytosis at the Children's Hospital of Eastern Ontario. Can J Surg. 2005 Jun;48(3):230-6. [PubMed] [PubMed Central]

3. Chadha M, Agarwal A, Agarwal N, Singh MK. Solitary eosinophilic granuloma of the radius. An unusual differential diagnosis. Acta Orthop Belg. 2007 Jun;73(3):413-7. [PubMed]

4. Bertram C, Madert J, Eggers C. Eosinophilic granuloma of the cervical spine. Spine (Phila Pa 1976). 2002 Jul 1;27(13):1408-13. [CrossRef] [PubMed]

5. Islinger RB, Kuklo TR, Owens BD, Horan PJ, Choma TJ, Murphey MD, Temple HT. Langerhans' cell histiocytosis in patients older than 21 years. Clin Orthop Relat Res. 2000 Oct;(379):231-5. [CrossRef] [PubMed]

6. Cochrane LA, Prince M, Clarke K. Langerhans' cell histiocytosis in the paediatric population: presentation and treatment of head and neck manifestations. J Otolaryngol. 2003 Feb;32(1):33-7. [CrossRef] [PubMed]

7. Jha SK, De Jesus O. Eosinophilic Granuloma. 2022 Sep 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. [PubMed]

8. Egeler RM, D'Angio GJ. Langerhans cell histiocytosis. J Pediatr. 1995 Jul;127(1):1-11. [CrossRef] [PubMed]

9. Binkovitz LA, Olshefski RS, Adler BH. Coincidence FDG-PET in the evaluation of Langerhans' cell histiocytosis: preliminary findings. Pediatr Radiol. 2003 Sep;33(9):598-602. [CrossRef] [PubMed]

10. Zhou Z, Zhang H, Guo C, Yu H, Wang L, Guo Q. Management of eosinophilic granuloma in pediatric patients: surgical intervention and surgery combined with postoperative radiotherapy and/or chemotherapy. Childs Nerv Syst. 2017 Apr;33(4):583-593. [CrossRef] [PubMed]

11. Kaste SC, Rodriguez-Galindo C, McCarville ME, Shulkin BL. PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Radiol. 2007 Jul;37(7):615-22. [CrossRef] [PubMed]

12. Huang W, Yang X, Cao D, Xiao J, Yang M, Feng D, Huang Q, Wu Z, Zheng W, Jia L, Wu S. Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome. Acta Neurochir (Wien). 2010 Jul;152(7):1129-37. [CrossRef] [PubMed]

13. Zhong N, Xu W, Meng T, Yang X, Yan W, Xiao J. The surgical strategy for eosinophilic granuloma of the pediatric cervical spine complicated with neurologic deficit and/or spinal instability. World J Surg Oncol. 2016 Dec 7;14(1):301. [CrossRef] [PubMed] [PubMed Central]

14. Floman Y, Bar-On E, Mosheiff R, Mirovsky Y, Robin GC, Ramu N. Eosinophilic granuloma of the spine. J Pediatr Orthop B. 1997 Oct;6(4):260-5. [CrossRef] [PubMed]

15. Garg S, Mehta S, Dormans JP. An atypical presentation of Langerhans cell histiocytosis of the cervical spine in a child. Spine (Phila Pa 1976). 2003 Nov 1;28(21):E445-8. [CrossRef] [PubMed]

16. Corby RR, Stacy GS, Peabody TD, Dixon LB. Radiofrequency ablation of solitary eosinophilic granuloma of bone. AJR Am J Roentgenol. 2008 Jun;190(6):1492-4. [CrossRef] [PubMed]

17. Richter MP, D'Angio GJ. The role of radiation therapy in the management of children with histiocytosis X. Am J Pediatr Hematol Oncol. 1981 Summer;3(2):161-3. [CrossRef] [PubMed]

18. Sessa S, Sommelet D, Lascombes P, Prévot J. Treatment of Langerhans-cell histiocytosis in children. Experience at the Children's Hospital of Nancy. J Bone Joint Surg Am. 1994 Oct;76(10):1513-25. [CrossRef] [PubMed]

19. Greenlee JD, Fenoy AJ, Donovan KA, Menezes AH. Eosinophilic granuloma in the pediatric spine. Pediatr Neurosurg. 2007;43(4):285-92. [CrossRef] [PubMed]

20. Egeler RM, de Kraker J, Voûte PA. Cytosine-arabinoside, vincristine, and prednisolone in the treatment of children with disseminated Langerhans cell histiocytosis with organ dysfunction: experience at a single institution. Med Pediatr Oncol. 1993;21(4):265-70. [CrossRef] [PubMed]

21. Capanna R, Springfield DS, Ruggieri P, Biagini R, Picci P, Bacci G, Giunti A, Lorenzi EG, Campanacci M. Direct cortisone injection in eosinophilic granuloma of bone: a preliminary report on 11 patients. J Pediatr Orthop. 1985 May-Jun;5(3):339-42. [CrossRef] [PubMed]

22. Egeler RM, Thompson RC Jr, Voûte PA, Nesbit ME Jr. Intralesional infiltration of corticosteroids in localized Langerhans' cell histiocytosis. J Pediatr Orthop. 1992 Nov-Dec;12(6):811-4. [CrossRef] [PubMed]

23. Arceci RJ, Brenner MK, Pritchard J. Controversies and new approaches to treatment of Langerhans cell histiocytosis. Hematol Oncol Clin North Am. 1998 Apr;12(2):339-57. [CrossRef] [PubMed]




How to Cite

Ozbek, M. A., Ipek, V., & Dinс C. (2023). Paradigm shift in vertebral eosinophilic granuloma. Ukrainian Neurosurgical Journal, 29(1), 30–37.



Original articles