Eosinophilic granuloma of the occipital bone in an adult: A case report

Eosinophilic granuloma (EG) refers to the most common and benign form of the disorder known as Langerhans’ cell histiocytosis. The disease is typically found in children and adolescents and rarely affects adults. We present a case of EG in the occipital bone in a 36-year-old man, who visited our hospital with the chief complaint of left occipital palpable tumor mass with local tenderness and pain for one month. An X-ray of the skull revealed a rounded osteolytic lesion. A computed tomography scan revealed a shadow of soft tissues in the left occipital site involving the entire thickness of the calvaria, which was indicative of marked destruction of the bone. The soft mass was successfully removed. The margins of the skull lesion were excised, and cranioplasty was performed simultaneously with bone cement. A definitive diagnosis of EG was made by histopathology and immunohistochemical detection of S-100 antigen in the tissue samples. With respect to management, we believe surgery is the best option for most accessible cranial lesions of EG. A cranioplasty with bone cement or autologous bone can be performed in the same session to repair the cranial defect.

摘要嗜伊紅性肉芽腫是蘭格罕細胞組織球增生症(Langerhans cell histocytosis)中最常見，且為良性的型態。此疾病常發生在兒童及青少年，成人的案例較少見。我們報告一個成人枕骨肉芽腫的案例。此一36歲男性主訴枕骨左側有局部壓痛的腫塊約月餘而來本院求診。頭骨X光顯示一圓形蝕骨病灶，頭部電腦斷層掃描則發現一軟組織病灶在枕骨左側且枕骨整層明顯受到破壞。手術將此軟組織病灶完整切除，病灶邊緣的頭骨亦將之切除，並施與顱骨整形術。術後的組織病理切片及免疫染色(S-100抗體)確診為嗜伊紅性肉芽腫。關於治療，我們認為，對於手術能夠切除的顱骨嗜伊紅性肉芽腫，手術是最佳的選擇。同次手術中，並施與以人工骨水泥或自體骨為材料的顱骨整形術來修補顱骨的缺損。