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DOI: 10.1055/s-2007-980172
© Georg Thieme Verlag KG Stuttgart · New York
Intradural Eosinophilic Granuloma with Intraparenchymal Invasion: A New Growth Pattern
Intradurales eosinophiles Granulom mit intraparenchymatöser Infiltration: Ein neues WachstumsmusterPublikationsverlauf
Publikationsdatum:
06. Juli 2007 (online)
![](https://www.thieme-connect.de/media/zblneurochir/200702/lookinside/thumbnails/10.1055-s-2007-980172-1.jpg)
Abstract
Background: Eosinophilic granuloma is a form of Langerhans’ cell histiocytosis, most commonly involving the skeletal system. We present the first case of an eosinophilic granuloma originating from the dura mater with secondary parenchymal and osseous invasion.
Case Report: A 32-year-old man was referred to us for headache and swelling in the right parietal region and a history of minor head trauma. The radiological and surgical findings were suggestive of meningosarcoma. Intraoperatively the lesion was found to originate from the dura mater. Histological diagnosis was eosinophilic granuloma. After a 21-month follow-up period, MRI was negative.
Conclusion: Intradural development is a possible growth pattern of eosinophilic granuloma. An inflammatory process of the dural membrane with migration of Langerhans’ cells could be the physiopathological basis for the formation of intradural eosinophilic granuloma. This is a mechanism similar to that of chronic subdural haematoma formation. Histological demonstration of eosinophilic granuloma cells around the lesion margin suggests the need to remove dura mater peripherally to the lesion.
Zusammenfassung
Das eosinophile Granulom ist eine Form der Langerhans-Zellhistiozytose, die am häufigsten das Skelettsystem betrifft. Wir demonstrieren den ersten Fall eines eosinophilen Granuloms, das von der Dura ausgehend sekundär das Hirnparenchym und den Knochen invadiert. Eine Hypothese für diesen pathophysiologischen Mechanismus wird vorgeschlagen.
Fallbericht: Ein 32-jähriger Mann wird wegen Kopfschmerzen und einer Schwellung der rechten Parietalregion nach der Vorgeschichte eines leichten Schädel-Hirn-Traumas vorgestellt. Die radiologischen und chirurgischen Befunde legen den Verdacht auf ein Meningosarkom nahe. Die histologische Diagnose ergibt ein eosinophiles Granulom. Bei einer 21 Monate später erfolgten Nachuntersuchung war die MRT ohne pathologischen Befund.
Schlussfolgerung: Die intradurale Ausdehnung ist ein mögliches Wachstumsmuster beim eosinophilen Granulom. Ein entzündlicher Prozess der Dura mit Migration von Langerhans-Zellen könnte die pathophysiologische Basis für die Ausbildung eines intraduralen eosinophilen Granuloms darstellen. Dieser Mechanismus ähnelt jenem bei der Entstehung eines chronisch subduralen Hämatoms. Der histologische Nachweis von Zellen eines eosinophilen Granuloms um die Läsionsränder herum legt die Notwendigkeit nahe, eine Duraexzision außerhalb des eigentlichen Randes der Läsion durchzuführen.
Key words
Eosinophilic granuloma - histiocytosis X - intradural - Langerhans' cell histiocytosis
Schlüsselwörter
Eosinophiles Granulom - Histozytose X - Langerhans-Zellenhistozytose
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Correspondence
Dr. E. CaroliMD
Department of Neurosciences
S Andrea Hospital
via Meropia, 85
Rome
Italy 00147
Telefon: +39/633/775 487
Fax: +39/644/888 057
eMail: manucarol2000@yahoo.it