Eosinophilic granuloma of the skull

Case contributed by Dr Chi Hau Tan

Presentation

30-year-old female with 2 months history of painful right frontal lump.

Patient Data

Age: 30
Gender: Female
Modality: CT

Lucent lesion in the right frontal bone, with involvement of both inner and outer tables of the skull, is noted.

Modality: MRI

The right frontal bony lesion demonstrates T2 hyperintensity and contrast enhancement, with extension into superficial soft tissue and deeper aspects, associated with diffuse enhancement of the right calvarial meninges and focal thickening of the meninges measuring 2mm. The lesion itself measures approximately 19 x 13 x 3mm. Diffuse enhancement of the overlying subcutaneous tissue is also noted. There is no evidence of vasogenic oedema or diffusion restriction.

Differential diagnoses include osteomyelitis of the right frontal bone with involvement of overlying soft tissue and underlying meninges, and inflammatory conditions such as oesinophilic granuloma.

Case Discussion

The patient underwent stereotactic burrhole biopsy of the right frontal lesion. The lesion was noted to have invaded the dura mater. There was no pus or evidence of infection intra-operatively.

Histopathology

Sections demonstrate an infiltrate of cells including lymphocytes, neutrophils, eosinophils and atypical histiocytic cells. The latter demonstrate moderately variable ovoid reniform nuclei with occasional nuclear grooves. The cells have a small-moderate amount of amphophilic cytoplasm. There are some multinucleate histiocytes. Immunoperoxidase stains show positive staining for S100 and CD1a. Features in keeping with Langerhans cell histiocytosis.

Case submitted by Dr Chi Hau Tan and A/Prof John Troupis

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Case Information

rID: 43022
Case created: 19th Feb 2016
Last edited: 22nd Mar 2017
Tag: skull
Inclusion in quiz mode: Included

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