3 y/o male, presented with a frontal lump. An x-ray demonstrated a lytic lesion. A Tc99m bone scan was requested to assess multifocal disease. Note moderate osteoblastic halo, with lytic center (arrows).
Alexiou et al reported 22 cases of pediatric patients harboring an eosinophilic granuloma (EG) of the skull. To rule out a multifocal disease, scintigraphy was performed in all cases preoperatively. EG was proven histo-pathologically. There was male predominance. Frontal bone was the most common affected bone. One patient had a multifocal disease. Surgical resection is the treatment of choice. Some patients were treated with sulfamethoxazole and trimethoprim for 6 months. Lesions were resolved and no tumor recurrence was noted.
References:
Alexiou GA, Mpairamidis E, Sfakianos G, Prodromou N. Cranial unifocal Langerhans cell histiocytosis in children. J Pediatr Surg. 2009 Mar;44(3):571-4.